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General NPI Number Information
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NPI Number | 1245051499
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Entity Type | Organization
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Legal Business Name | MENTAL WELLNESS PLLC
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Dates
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Enumeration Date | 10/21/2024
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Last Update Date | 10/21/2024
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Provider Practice Location Address
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Address Line | 26411 OAK RIDGE DR
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City | SPRING
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State | TX
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Zip | 77380-1964
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Country | US
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Telephone | 936-287-3518
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Fax |
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Provider Business Mailing Address
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Address Line | 26411 OAK RIDGE DR
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City | SPRING
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State | TX
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Zip | 77380-1964
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Country | US
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Telephone | 936-287-3518
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | PATRICIA BROUSSARD
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Credential | LMFT
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Telephone | 936-264-6682
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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