Healthcare Provider Details

I. General information

NPI: 1811554728
Provider Name (Legal Business Name): ANCIENT WISDOM HOLISTIC WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2019
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 SELINSKY RD APT 44
HOUSTON TX
77048-1930
US

IV. Provider business mailing address

5901 SELINSKY RD APT 44
HOUSTON TX
77048-1930
US

V. Phone/Fax

Practice location:
  • Phone: 346-291-8232
  • Fax:
Mailing address:
  • Phone: 346-291-8232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. MICHELLE CLAY
Title or Position: CO-OWNER
Credential: LMT
Phone: 346-277-5938