Provider Demographics
NPI:1922657477
Name:REFRESH WELLNESS & COUNSELING LLC
Entity Type:Organization
Organization Name:REFRESH WELLNESS & COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:IVY
Authorized Official - Middle Name:
Authorized Official - Last Name:PELLERITO
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:816-427-1828
Mailing Address - Street 1:208 SE 3RD ST STE 2
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64063-2762
Mailing Address - Country:US
Mailing Address - Phone:816-427-1828
Mailing Address - Fax:
Practice Address - Street 1:208 SE 3RD ST STE 2
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64063-2762
Practice Address - Country:US
Practice Address - Phone:816-427-1828
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-07
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)