Provider Demographics
NPI:1528605524
Name:WELLNESS FAMILY COUNSELING LLC
Entity Type:Organization
Organization Name:WELLNESS FAMILY COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:
Authorized Official - Last Name:VOVILLIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-847-9172
Mailing Address - Street 1:2156 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-1315
Mailing Address - Country:US
Mailing Address - Phone:303-847-9172
Mailing Address - Fax:
Practice Address - Street 1:229 TERRY ST
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-5930
Practice Address - Country:US
Practice Address - Phone:303-847-9172
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-09
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health