Provider Demographics
NPI:1336865294
Name:THE WELLNESS PROJECT LLC
Entity type:Organization
Organization Name:THE WELLNESS PROJECT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SCHOOL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:SHANAE
Authorized Official - Middle Name:ROCHELLE
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:PUPIL PERSONNEL SERV
Authorized Official - Phone:214-475-6331
Mailing Address - Street 1:3200 E GUASTI RD STE 100
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-8661
Mailing Address - Country:US
Mailing Address - Phone:214-475-6331
Mailing Address - Fax:909-614-7300
Practice Address - Street 1:1404 BRIMWOOD DR
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75072-7119
Practice Address - Country:US
Practice Address - Phone:909-838-3521
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-12
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Multi-Specialty