=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437736576
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARRIAGE AND FAMILY WELLNESS CENTER PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/25/2021
-----------------------------------------------------
Last Update Date | 04/06/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4800 N 10TH ST STE D
-----------------------------------------------------
City | MCALLEN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78504-2874
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-345-5444
-----------------------------------------------------
Fax | 866-252-6652
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2305 INGELS PL
-----------------------------------------------------
City | NORMAN
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73071-3956
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-345-5444
-----------------------------------------------------
Fax | 866-252-6652
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DAVID SAAVEDRA
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 956-345-5444
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------