| Wolf Creek Wellness Llc | |
|
680 High St Ste A Wadsworth OH 44281-1690 | |
| (306) 902-3373 | |
| (330) 822-6955 |
| Full Name | Wolf Creek Wellness Llc |
|---|---|
| Speciality | Counselor |
| Location | 680 High St Ste A, Wadsworth, Ohio |
| Authorized Official Name and Position | Richard Maroon (CLINICAL DIRECTOR) |
| Authorized Official Contact | 3306902337 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wolf Creek Wellness Llc 680 High St Ste A Wadsworth OH 44281-1690 Ph: (330) 690-2337 | Wolf Creek Wellness Llc 680 High St Ste A Wadsworth OH 44281-1690 Ph: (306) 902-3373 |
| NPI Number | 1003355090 |
|---|---|
| Provider Enumeration Date | 02/23/2017 |
| Last Update Date | 03/06/2023 |
| Certification Date | 03/06/2023 |
| Medicare PECOS PAC ID | 4486076718 |
|---|---|
| Medicare Enrollment ID | O20200615002730 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003355090 | NPI | - | NPPES |
| E.0007875 | Other | OH | LICENSE |
| 0251028 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | 34.009421 (Ohio) | Primary |
| Provider Name | Jan M Maynor |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1841368099 PECOS PAC ID: 8426066408 Enrollment ID: I20060403000349 |
| Provider Name | Cheryl Max Van Dyke |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1841314085 PECOS PAC ID: 3971577370 Enrollment ID: I20200615002940 |
| Provider Name | Richard Maroon |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1861678849 PECOS PAC ID: 6002180593 Enrollment ID: I20240118004189 |
| Provider Name | Shannon Anne Kahle |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1548826530 PECOS PAC ID: 5799138970 Enrollment ID: I20240124003727 |
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