Provider Demographics
NPI:1477152809
Name:WELLOVATION PLLC
Entity Type:Organization
Organization Name:WELLOVATION PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:AMUNDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-792-1943
Mailing Address - Street 1:10538 LEGACY CV
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-4475
Mailing Address - Country:US
Mailing Address - Phone:210-792-1943
Mailing Address - Fax:
Practice Address - Street 1:2101 LOCKHILL SELMA RD STE 210
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78213-1409
Practice Address - Country:US
Practice Address - Phone:210-792-1943
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WELLOVATION PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-10-16
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
76536OtherPSYCHOLOGY, COUNSELOR, PSYCHIATRY