Provider Demographics
NPI:1811258478
Name:WELLNESS FIRST LLC
Entity type:Organization
Organization Name:WELLNESS FIRST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:KOST
Authorized Official - Suffix:
Authorized Official - Credentials:MS,LMHC,LNN
Authorized Official - Phone:561-445-5430
Mailing Address - Street 1:6699 N FEDERAL HWY
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-1660
Mailing Address - Country:US
Mailing Address - Phone:561-445-5430
Mailing Address - Fax:
Practice Address - Street 1:6699 N FEDERAL HWY
Practice Address - Street 2:SUITE 104
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-1660
Practice Address - Country:US
Practice Address - Phone:561-445-5430
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-30
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH7046101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty