Provider Demographics
NPI:1689415564
Name:WANDERLUST WELLNESS COUNSELING LLC
Entity type:Organization
Organization Name:WANDERLUST WELLNESS COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, LCPC/PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:M
Authorized Official - Last Name:LETTERLE
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LCPC, PEL
Authorized Official - Phone:815-600-1353
Mailing Address - Street 1:305 E SHORT DR
Mailing Address - Street 2:
Mailing Address - City:COAL CITY
Mailing Address - State:IL
Mailing Address - Zip Code:60416-4108
Mailing Address - Country:US
Mailing Address - Phone:815-600-1353
Mailing Address - Fax:
Practice Address - Street 1:305 E SHORT DR
Practice Address - Street 2:
Practice Address - City:COAL CITY
Practice Address - State:IL
Practice Address - Zip Code:60416-4108
Practice Address - Country:US
Practice Address - Phone:815-600-1353
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-04
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty