Provider Demographics
NPI:1831874023
Name:RECLAIM WELLNESS GROUP
Entity type:Organization
Organization Name:RECLAIM WELLNESS GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CLEMENT
Authorized Official - Middle Name:STREET
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:502-777-3188
Mailing Address - Street 1:4010 DUPONT CIR STE 600
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4883
Mailing Address - Country:US
Mailing Address - Phone:502-758-9878
Mailing Address - Fax:
Practice Address - Street 1:4010 DUPONT CIR STE 600
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4883
Practice Address - Country:US
Practice Address - Phone:502-758-9878
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-16
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty