Provider Demographics
NPI:1255807244
Name:WHEATON WELLNESS CENTER, INC.
Entity type:Organization
Organization Name:WHEATON WELLNESS CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARGO
Authorized Official - Middle Name:ALENA
Authorized Official - Last Name:MCCOLLISTER
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:630-664-1449
Mailing Address - Street 1:616 N LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-1218
Mailing Address - Country:US
Mailing Address - Phone:630-664-1449
Mailing Address - Fax:
Practice Address - Street 1:212 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-5232
Practice Address - Country:US
Practice Address - Phone:630-664-1449
Practice Address - Fax:331-806-3939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-17
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty