| Wheelhouse Therapy, Llc | |
|
1722 S Glenstone Ave Ste H Springfield MO 65804-1513 | |
| (417) 543-3043 | |
| Not Available |
| Full Name | Wheelhouse Therapy, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1722 S Glenstone Ave Ste H, Springfield, Missouri |
| Authorized Official Name and Position | Ethan Potter (OWNER/THERAPIST) |
| Authorized Official Contact | 4175433043 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wheelhouse Therapy, Llc 2135 E Independence St # 1033 Springfield MO 65804-3749 Ph: (417) 543-3043 | Wheelhouse Therapy, Llc 1722 S Glenstone Ave Ste H Springfield MO 65804-1513 Ph: (417) 543-3043 |
| NPI Number | 1447099825 |
|---|---|
| Provider Enumeration Date | 05/23/2024 |
| Last Update Date | 05/23/2024 |
| Certification Date | 05/23/2024 |
| Medicare PECOS PAC ID | 2860939832 |
|---|---|
| Medicare Enrollment ID | O20240808000485 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447099825 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Ethan Potter |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1275188799 PECOS PAC ID: 7012386493 Enrollment ID: I20221206003051 |
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