Healthcare Provider Details

I. General information

NPI: 1831903988
Provider Name (Legal Business Name): WESOURCE WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2025
Last Update Date: 02/06/2025
Certification Date: 02/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6726 RAMBLING MANOR CT
RICHMOND TX
77469-6098
US

IV. Provider business mailing address

6726 RAMBLING MANOR CT
RICHMOND TX
77469-6098
US

V. Phone/Fax

Practice location:
  • Phone: 619-385-3786
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE SHAE CORRELL
Title or Position: FOUNDER, CEO
Credential:
Phone: 619-385-3786