Healthcare Provider Details

I. General information

NPI: 1760939409
Provider Name (Legal Business Name): WHOLE HEALTH PROFESSIONAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2016
Last Update Date: 09/14/2023
Certification Date: 09/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6100 CORPORATE DR STE 3A
HOUSTON TX
77036-3419
US

IV. Provider business mailing address

6100 CORPORATE DR STE 3A
HOUSTON TX
77036-3419
US

V. Phone/Fax

Practice location:
  • Phone: 832-659-9389
  • Fax:
Mailing address:
  • Phone: 832-659-9389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License NumberQ3834
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. HUIPING XU
Title or Position: MD
Credential:
Phone: 832-659-9389