Provider Demographics
NPI:1649354077
Name:WELLNESS COUNSELING CENTER, L.L.C.
Entity type:Organization
Organization Name:WELLNESS COUNSELING CENTER, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/PSYCHO THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CARY
Authorized Official - Middle Name:
Authorized Official - Last Name:BACKENGER
Authorized Official - Suffix:
Authorized Official - Credentials:MS,CADAIII,CEDS,LPC
Authorized Official - Phone:920-733-1992
Mailing Address - Street 1:103 W COLLEGE AVE
Mailing Address - Street 2:SUITE 815
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-5770
Mailing Address - Country:US
Mailing Address - Phone:920-733-1992
Mailing Address - Fax:920-733-1866
Practice Address - Street 1:103 W COLLEGE AVE
Practice Address - Street 2:SUITE 815
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-5770
Practice Address - Country:US
Practice Address - Phone:920-733-1992
Practice Address - Fax:920-733-1866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1982101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty