| Roundtable Wellness | |
|
904 South St Lafayette IN 47901-1416 | |
| (765) 630-7222 | |
| Not Available |
| Full Name | Roundtable Wellness |
|---|---|
| Speciality | Counselor |
| Location | 904 South St, Lafayette, Indiana |
| Authorized Official Name and Position | Renee M Tilt (OWNER & REGISTERED DIETITIAN) |
| Authorized Official Contact | 7656307222 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Roundtable Wellness 904 South St Lafayette IN 47901-1416 Ph: (765) 630-7222 | Roundtable Wellness 904 South St Lafayette IN 47901-1416 Ph: (765) 630-7222 |
| NPI Number | 1013366251 |
|---|---|
| Provider Enumeration Date | 06/08/2016 |
| Last Update Date | 12/23/2024 |
| Certification Date | 12/23/2024 |
| Medicare PECOS PAC ID | 7810276060 |
|---|---|
| Medicare Enrollment ID | O20161111000627 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013366251 | NPI | - | NPPES |
| Provider Name | Emily Ervin |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1134713308 PECOS PAC ID: 4183159635 Enrollment ID: I20250604002331 |
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