Provider Demographics
NPI:1720276603
Name:WELLNESS PROJECT PLLC
Entity Type:Organization
Organization Name:WELLNESS PROJECT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICIAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:POTTER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:405-321-6211
Mailing Address - Street 1:900 N PORTER AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73071-6425
Mailing Address - Country:US
Mailing Address - Phone:405-321-6211
Mailing Address - Fax:405-321-6211
Practice Address - Street 1:900 N PORTER AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071-6425
Practice Address - Country:US
Practice Address - Phone:405-321-6211
Practice Address - Fax:405-321-6211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-04
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK24381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty