Maitri Path to Wellness, PLLC
Organization Active NPI Substance Use Disorder Rehabilitation Clinic/Center · Wyoming, IL
NPI 1598564429 · NPPES record last updated Mar 12, 2025
Key facts
- NPI
- 1598564429
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X
- Legal business name
- MAITRI PATH TO WELLNESS, PLLC
- Practice address
- 101 W Williams St
Wyoming, IL 61491-1347 - Phone
- (815) 780-0690
- Fax
- (815) 410-1937
- NPI assigned
- Mar 12, 2025
- Organization subpart
- No
Authorized official
- Name
- Brenden Fasken
- Title
- Chief Operating Officer
- Phone
- (815) 780-0690
Corporate family (same tax ID) 4
Practitioners 1
National Provider Directory
- Tax ID family
- Maitri Path to Wellness PLLC
Locations
101 W Williams St
Wyoming, IL 61491
Phone (815) 780-0690
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Substance Use Disorder Rehabilitation Clinic/Center | 261QR0405X | Yes |
Addresses
Primary practice location
101 W Williams St
Wyoming, IL 61491-1347
Mailing address
710 Peoria St
Peru, IL 61354-3262
Phone (815) 780-0690
Other practice location 1
710 Peoria St
Peru, IL 61354-3262
Phone (815) 780-0690
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- Natasha Terwilliger
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All providers in Wyoming, IL · Substance Use Disorder Rehabilitation Clinic/Center in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 12, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.