| Wellness Institute Llc | |
|
752 Bagnell Dam Blvd Ste B Lake Ozark MO 65049-8716 | |
| (573) 693-1119 | |
| (573) 557-4163 |
| Full Name | Wellness Institute Llc |
|---|---|
| Speciality | Counselor |
| Location | 752 Bagnell Dam Blvd Ste B, Lake Ozark, Missouri |
| Authorized Official Name and Position | Cibele F C Elliott (CLINICAL THERAPIST) |
| Authorized Official Contact | 5734803501 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wellness Institute Llc 752 Bagnell Dam Blvd Ste B Lake Ozark MO 65049-8716 Ph: (573) 693-1119 | Wellness Institute Llc 752 Bagnell Dam Blvd Ste B Lake Ozark MO 65049-8716 Ph: (573) 693-1119 |
| NPI Number | 1124632492 |
|---|---|
| Provider Enumeration Date | 09/03/2020 |
| Last Update Date | 01/25/2024 |
| Certification Date | 01/12/2024 |
| Medicare PECOS PAC ID | 1153766050 |
|---|---|
| Medicare Enrollment ID | O20240301001764 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124632492 | NPI | - | NPPES |
| 1111582 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101Y00000X | Counselor | (* (Not Available)) | Primary |
| Provider Name | Amber Dawn Johnson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1326526542 PECOS PAC ID: 2062742349 Enrollment ID: I20190930002323 |
| Provider Name | Cibele F.c. Elliott |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1053750869 PECOS PAC ID: 0244675155 Enrollment ID: I20240301002149 |
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