Provider Demographics
NPI:1457097560
Name:J.F. WILSON WELLNESS CENTER, LLC.
Entity Type:Organization
Organization Name:J.F. WILSON WELLNESS CENTER, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANA
Authorized Official - Middle Name:FAYE
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:270-816-2671
Mailing Address - Street 1:560 OAKLAND CIR
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-8924
Mailing Address - Country:US
Mailing Address - Phone:270-558-5173
Mailing Address - Fax:
Practice Address - Street 1:570 OAKLAND CIR
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-8924
Practice Address - Country:US
Practice Address - Phone:270-558-5173
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-11
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health