| NPI | 1831951300 |
|---|---|
| Doing Business As | MODERN WELLNESS |
| Entity Type | Organization |
| Authorized Contact | JESSICA SHAW Lpc 262-221-0369 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2024-01-29 |
| Last Update Date | 2026-01-28 |