=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629708003
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CALM VIBRATIONS COUNSELING & WELLNESS, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/16/2022
-----------------------------------------------------
Last Update Date | 07/28/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 610 N LOOP 336 E STE 123
-----------------------------------------------------
City | CONROE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77301-1437
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-626-0455
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 483
-----------------------------------------------------
City | GEORGETOWN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78627-0483
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-626-0455
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PSYCHOTHERAPY
-----------------------------------------------------
Name | KELI HEMINGWAY
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 512-626-0455
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------