Provider Demographics
NPI:1407246861
Name:THE WELLNESS COUNSELING CENTER, LLC
Entity Type:Organization
Organization Name:THE WELLNESS COUNSELING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:HEATHER
Authorized Official - Last Name:HISER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:816-225-2024
Mailing Address - Street 1:1304 S. MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:HARRISONVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64701
Mailing Address - Country:US
Mailing Address - Phone:816-225-2024
Mailing Address - Fax:
Practice Address - Street 1:200 B ST
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:MO
Practice Address - Zip Code:64012-2402
Practice Address - Country:US
Practice Address - Phone:816-225-2024
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-23
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010021053101YP2500X
MO2010036629103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty