Provider Demographics
NPI:1639547193
Name:WELLNESS ASSOCIATES, LLC
Entity Type:Organization
Organization Name:WELLNESS ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:TAD
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:MED NCC LPC
Authorized Official - Phone:307-630-3466
Mailing Address - Street 1:1471 DEWAR DR # 204
Mailing Address - Street 2:
Mailing Address - City:ROCK SPRINGS
Mailing Address - State:WY
Mailing Address - Zip Code:82901-5814
Mailing Address - Country:US
Mailing Address - Phone:307-630-3466
Mailing Address - Fax:
Practice Address - Street 1:1471 DEWAR DR # 204
Practice Address - Street 2:
Practice Address - City:ROCK SPRINGS
Practice Address - State:WY
Practice Address - Zip Code:82901-5814
Practice Address - Country:US
Practice Address - Phone:307-630-3466
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-14
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY1198251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health