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General NPI Number Information
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NPI Number | 1063660124
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Entity Type | Organization
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Legal Business Name | BEATITUDES WELLNESS CENTER LLC
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Dates
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Enumeration Date | 09/03/2008
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Last Update Date | 04/10/2024
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Provider Practice Location Address
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Address Line | 16015 CAIRNWAY DR. #841077
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City | HOUSTON
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State | TX
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Zip | 77284-1077
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Country | US
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Telephone | 832-230-4158
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 841077
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City | HOUSTON
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State | TX
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Zip | 77284-1077
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Country | US
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Telephone | 832-230-4158
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MRS. PATRICIA JOHNSON
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Credential | M.A., LPC-S
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Telephone | 832-230-4158
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 62194
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License Number State | TX
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