Provider Demographics
NPI:1053911776
Name:WELLNESS WORK COUNSELING SERVICE PLLC
Entity type:Organization
Organization Name:WELLNESS WORK COUNSELING SERVICE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CARTELIA
Authorized Official - Middle Name:T
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, NCC
Authorized Official - Phone:512-575-4671
Mailing Address - Street 1:3016 POLAR LN STE 207
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-3039
Mailing Address - Country:US
Mailing Address - Phone:512-575-4671
Mailing Address - Fax:
Practice Address - Street 1:3016 POLAR LN STE 207
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-3039
Practice Address - Country:US
Practice Address - Phone:512-575-4671
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health