Provider Demographics
NPI:1932456134
Name:THE WELLNESS GROUP, LLC
Entity Type:Organization
Organization Name:THE WELLNESS GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:BA, MS, NCC, LPC
Authorized Official - Phone:205-280-7733
Mailing Address - Street 1:232 TOWN MART
Mailing Address - Street 2:
Mailing Address - City:CLANTON
Mailing Address - State:AL
Mailing Address - Zip Code:35045-3784
Mailing Address - Country:US
Mailing Address - Phone:205-280-7733
Mailing Address - Fax:205-280-7733
Practice Address - Street 1:232 TOWN MART
Practice Address - Street 2:
Practice Address - City:CLANTON
Practice Address - State:AL
Practice Address - Zip Code:35045-3784
Practice Address - Country:US
Practice Address - Phone:205-280-7733
Practice Address - Fax:205-280-7733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-07
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2723101YM0800X, 101YP2500X, 103K00000X, 106H00000X
AL1406103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51131358OtherBLUE CROSS BLUE SHIELD
AL719746OtherVALUEOPTIONS
AL1932456134Medicaid