Provider Demographics
NPI:1578369419
Name:ST JUDES WELLNESS
Entity type:Organization
Organization Name:ST JUDES WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUDE
Authorized Official - Middle Name:NNAMDI
Authorized Official - Last Name:OKEKE
Authorized Official - Suffix:
Authorized Official - Credentials:MSC, NCC, ALPC
Authorized Official - Phone:484-860-8379
Mailing Address - Street 1:4128 W CHESTER PIKE
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19073-3129
Mailing Address - Country:US
Mailing Address - Phone:484-860-8379
Mailing Address - Fax:
Practice Address - Street 1:4128 W CHESTER PIKE
Practice Address - Street 2:
Practice Address - City:NEWTOWN SQ
Practice Address - State:PA
Practice Address - Zip Code:19073-3129
Practice Address - Country:US
Practice Address - Phone:484-860-8379
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-21
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty