Healthcare Provider Details

I. General information

NPI: 1679340293
Provider Name (Legal Business Name): BELUXXE HEALTH AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2023
Last Update Date: 12/04/2023
Certification Date: 12/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 OIL CENTER DRIVE SUITE 104B
LAFAYETTE LA
70503-2482
US

IV. Provider business mailing address

349 MARYVIEW FARM ROAD
LAFAYETTE LA
70507
US

V. Phone/Fax

Practice location:
  • Phone: 337-549-5800
  • Fax:
Mailing address:
  • Phone: 337-212-4122
  • Fax: 877-515-1665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RAQUEL MCCORVEY
Title or Position: MANAGER
Credential: FNP-C, PMHNP-BC
Phone: 337-212-4122