Provider Demographics
NPI:1497810477
Name:WELLNESS COUNSELING CENTER
Entity Type:Organization
Organization Name:WELLNESS COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:SYLVIA
Authorized Official - Middle Name:ORLINDA
Authorized Official - Last Name:MAREZ-FRANSUA
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:719-547-3829
Mailing Address - Street 1:301 N MAIN ST STE 110
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-3257
Mailing Address - Country:US
Mailing Address - Phone:719-547-3829
Mailing Address - Fax:719-546-1942
Practice Address - Street 1:301 N MAIN ST STE 110
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-3257
Practice Address - Country:US
Practice Address - Phone:719-547-3829
Practice Address - Fax:719-546-1942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9896691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO016483Medicaid