Provider Demographics
NPI:1720688591
Name:WELLNESS PATH THERAPY CENTER
Entity Type:Organization
Organization Name:WELLNESS PATH THERAPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LEAD THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:AJIBOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:OBAJIMI
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:312-305-1007
Mailing Address - Street 1:1133 E 83RD ST UNIT 172
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60619-6400
Mailing Address - Country:US
Mailing Address - Phone:312-305-1007
Mailing Address - Fax:773-207-5335
Practice Address - Street 1:1133 E 83RD ST UNIT 172
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60619-6400
Practice Address - Country:US
Practice Address - Phone:312-305-1007
Practice Address - Fax:773-207-5335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-29
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty