MEDICARE: KICKNOWLEDGE EDUCATION & WELLNESS

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101Y00000X	Counselor
2	171400000X	Health & Wellness Coach
3	251B00000X	Case Management Agency
4	261QM0855X	Adolescent and Children Mental Health Clinic/Center
5	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1770255309
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KICKNOWLEDGE EDUCATION & WELLNESS

Provider Business Mailing Address
First Line	:	2401 FOUNTAIN VIEW DR # 2430
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77057-4827
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2401 FOUNTAIN VIEW DR # 2430
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77057-4827
Country	:	US
Telephone Number	:	832-501-0997
Fax Number	:

Authorized Official
Title or Position	:	C0-OWNER
Name	:	MRS. TENESHA WILLIAMS
Credential	:
Telephone Number	:	281-774-8478

Provider Enumeration Date	:	10/01/2021
Last Update Date	:	01/26/2022

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Directions to “KICKNOWLEDGE EDUCATION & WELLNESS ” Practice Location

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