Healthcare Provider Details

I. General information

NPI: 1417476284
Provider Name (Legal Business Name): LONGVIEW WELLNESS CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2017
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1107 E MARSHALL AVE
LONGVIEW TX
75601-5602
US

IV. Provider business mailing address

1107 E MARSHALL AVE
LONGVIEW TX
75601-5602
US

V. Phone/Fax

Practice location:
  • Phone: 903-758-2610
  • Fax: 903-758-7081
Mailing address:
  • Phone: 903-758-2610
  • Fax: 903-758-7081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StateTX

VIII. Authorized Official

Name: TIMOTHY CHAD JONES
Title or Position: CEO
Credential:
Phone: 903-758-2610