Provider Demographics
NPI:1497304158
Name:WELLNESS COUNSELING CENTER, LLC
Entity Type:Organization
Organization Name:WELLNESS COUNSELING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRIMLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:801-735-8898
Mailing Address - Street 1:1314 S KING ST STE 1460
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-1948
Mailing Address - Country:US
Mailing Address - Phone:801-735-8898
Mailing Address - Fax:
Practice Address - Street 1:1314 S KING ST STE 1460
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-1948
Practice Address - Country:US
Practice Address - Phone:801-735-8898
Practice Address - Fax:866-230-2579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-05
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI823577Medicaid