Provider Demographics
NPI:1356074876
Name:CONNECTIVE CLINICAL WELLNESS
Entity Type:Organization
Organization Name:CONNECTIVE CLINICAL WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:TRISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:OWSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC-S, LICDC
Authorized Official - Phone:740-247-5463
Mailing Address - Street 1:PO BOX 134
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:OH
Mailing Address - Zip Code:45779-0134
Mailing Address - Country:US
Mailing Address - Phone:740-247-5463
Mailing Address - Fax:740-212-8445
Practice Address - Street 1:2448 THIRD STREET
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:OH
Practice Address - Zip Code:45779-0134
Practice Address - Country:US
Practice Address - Phone:740-247-5463
Practice Address - Fax:740-212-8445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-01
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty