Provider Demographics
NPI:1356056584
Name:WELLNESS COUCH THERAPEUTIC SPA & TREATMENT CENTER
Entity type:Organization
Organization Name:WELLNESS COUCH THERAPEUTIC SPA & TREATMENT CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:HARDEN-MADDOX
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC, CADC
Authorized Official - Phone:708-953-9355
Mailing Address - Street 1:20015 S LAGRANGE RD STE 1269
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-3104
Mailing Address - Country:US
Mailing Address - Phone:708-953-9355
Mailing Address - Fax:
Practice Address - Street 1:2946 CARMEL DRIVE
Practice Address - Street 2:
Practice Address - City:FLOSSMOOR
Practice Address - State:IL
Practice Address - Zip Code:60422
Practice Address - Country:US
Practice Address - Phone:708-953-9355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-23
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty