Provider Demographics
NPI:1124632492
Name:WELLNESS INSTITUTE LLC
Entity type:Organization
Organization Name:WELLNESS INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:CIBELE
Authorized Official - Middle Name:F C
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MED / LPC/ EMDR
Authorized Official - Phone:573-480-3501
Mailing Address - Street 1:752 BAGNELL DAM BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:LAKE OZARK
Mailing Address - State:MO
Mailing Address - Zip Code:65049-8716
Mailing Address - Country:US
Mailing Address - Phone:573-693-1119
Mailing Address - Fax:573-557-4163
Practice Address - Street 1:752 BAGNELL DAM BLVD STE B
Practice Address - Street 2:
Practice Address - City:LAKE OZARK
Practice Address - State:MO
Practice Address - Zip Code:65049-8716
Practice Address - Country:US
Practice Address - Phone:573-693-1119
Practice Address - Fax:573-557-4163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-03
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1111582Medicaid