Provider Demographics
NPI:1699532010
Name:THE WELLNESS COUCH
Entity type:Organization
Organization Name:THE WELLNESS COUCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HARDEN-MADDOX
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:708-953-9355
Mailing Address - Street 1:4610 N CLARK ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-4620
Mailing Address - Country:US
Mailing Address - Phone:708-953-9355
Mailing Address - Fax:
Practice Address - Street 1:2946 CARMEL DR
Practice Address - Street 2:
Practice Address - City:FLOSSMOOR
Practice Address - State:IL
Practice Address - Zip Code:60422-2284
Practice Address - Country:US
Practice Address - Phone:708-953-9355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-01
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty