MEDICARE: MAJESTIC WELLNESS RETREAT LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1396604476
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAJESTIC WELLNESS RETREAT LLC

Provider Business Mailing Address
First Line	:	16310 TOMBALL PKWY # 1404
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77064-1812
Country	:	US
Telephone Number	:	281-653-9205
Fax Number	:

Provider Business Practice Location Address
First Line	:	16310 TOMBALL PKWY # 1404
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77064-1812
Country	:	US
Telephone Number	:	281-653-9205
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	TIFFANY J HENDERSON
Credential	:
Telephone Number	:	281-653-9205

Provider Enumeration Date	:	01/15/2026
Last Update Date	:	01/15/2026

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