Provider Demographics
NPI:1679828222
Name:WELLHEALTH GROUP, LLC
Entity Type:Organization
Organization Name:WELLHEALTH GROUP, LLC
Other - Org Name:WELLHEALTH GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LOON-TZIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-925-7525
Mailing Address - Street 1:6614 CLAYTON RD
Mailing Address - Street 2:SUITE 133
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-1602
Mailing Address - Country:US
Mailing Address - Phone:314-925-7525
Mailing Address - Fax:314-925-7525
Practice Address - Street 1:916 OLIVE ST
Practice Address - Street 2:SUITE 0304
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63101-1459
Practice Address - Country:US
Practice Address - Phone:314-925-7525
Practice Address - Fax:314-925-7525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-19
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO19991378802084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty