Provider Demographics
NPI:1568273159
Name:THE LIVING ROOM WELLNESS CENTER, LLC
Entity type:Organization
Organization Name:THE LIVING ROOM WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHELSEA
Authorized Official - Middle Name:
Authorized Official - Last Name:GILLIAM, PSY.D.
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:417-274-0297
Mailing Address - Street 1:1050 E WALNUT ST STE A
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65806-2637
Mailing Address - Country:US
Mailing Address - Phone:417-413-4774
Mailing Address - Fax:
Practice Address - Street 1:1050 E WALNUT ST STE A
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65806-2637
Practice Address - Country:US
Practice Address - Phone:417-413-4774
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-14
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty