Provider Demographics
NPI:1407634819
Name:WELLNESS PATH COUNSELING SERVICES LLC
Entity Type:Organization
Organization Name:WELLNESS PATH COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEISY
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:847-220-7286
Mailing Address - Street 1:PO BOX 1302
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60011-1302
Mailing Address - Country:US
Mailing Address - Phone:847-220-7286
Mailing Address - Fax:
Practice Address - Street 1:3245 GROVE AVE STE 208
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-3476
Practice Address - Country:US
Practice Address - Phone:847-220-7286
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty