The Wellness Collective Boutique

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

THE WELLNESS COLLECTIVE BOUTIQUE

Practice address

7901 4TH St N Ste 300
St Petersburg, FL 33702-4399

Phone

(407) 921-6276

NPI assigned

Aug 18, 2025

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Nyesha Logan, LCSWNPI 1306528393

Title

Co-Owner

Phone

(407) 921-6276

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Nyesha Logan, LCSW

  • Clinical Social Worker
  • Eatonville, FL
  • NPI 1306528393
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1755475200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1755475200000",
    "number": "1174400543",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5707 CREEK DALE DR",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328103981",
            "telephone_number": "407-921-6276"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7901 4TH ST N STE 300",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337024399",
            "telephone_number": "407-921-6276"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE WELLNESS COLLECTIVE BOUTIQUE",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-08-18",
        "last_updated": "2025-08-18",
        "certification_date": "2025-08-18",
        "status": "A",
        "authorized_official_last_name": "LOGAN",
        "authorized_official_first_name": "NYESHA",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "407-921-6276",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• The Wellness Nurse Concierge Lab Services L.L.C.
• The Wilson Approach
• Crisha Massieu Thebeau, LMHC
• Jomon John Thekkethottiyil
• Karen Theobald, ARNP

• Clinical Social Worker in St Petersburg, FL
• Providers in St Petersburg, FL by specialty
• Clinical Social Worker in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.