Provider Demographics
NPI:1609406479
Name:ESSENTIAL WELLNESS, LLC
Entity Type:Organization
Organization Name:ESSENTIAL WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:C
Authorized Official - Last Name:BRADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LSCSW
Authorized Official - Phone:785-259-3880
Mailing Address - Street 1:2887 SW MACVICAR AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66611-1782
Mailing Address - Country:US
Mailing Address - Phone:785-260-0272
Mailing Address - Fax:785-408-1862
Practice Address - Street 1:2887 SW MACVICAR AVE # 110
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66611-1782
Practice Address - Country:US
Practice Address - Phone:785-259-3880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-21
Last Update Date:2020-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200666160CMedicaid