| Center For Personal Wellness, Llc | |
|
96 W 4th St Minster OH 45865-1090 | |
| (419) 628-0124 | |
| Not Available |
| Full Name | Center For Personal Wellness, Llc |
|---|---|
| Speciality | Counselor |
| Location | 96 W 4th St, Minster, Ohio |
| Authorized Official Name and Position | Laura Roetgerman (CONSULTANT) |
| Authorized Official Contact | 4196280124 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Center For Personal Wellness, Llc 96 W 4th St Minster OH 45865-1090 Ph: (419) 628-0124 | Center For Personal Wellness, Llc 96 W 4th St Minster OH 45865-1090 Ph: (419) 628-0124 |
| NPI Number | 1437490877 |
|---|---|
| Provider Enumeration Date | 03/11/2013 |
| Last Update Date | 05/11/2016 |
| Medicare PECOS PAC ID | 6507202256 |
|---|---|
| Medicare Enrollment ID | O20240315002928 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437490877 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | 180008510 (Illinois) | Primary |
| Provider Name | Emily Long |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1114403896 PECOS PAC ID: 6901280841 Enrollment ID: I20220826001319 |
| Provider Name | Cristina L Khuth |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1043785322 PECOS PAC ID: 2860863065 Enrollment ID: I20230126001486 |
| Provider Name | Dylan Brody Gillis |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1588220263 PECOS PAC ID: 5597101253 Enrollment ID: I20240315003004 |
| Provider Name | Rebecca Alice Encinas |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1265199327 PECOS PAC ID: 2163956095 Enrollment ID: I20241114000596 |