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General NPI Number Information
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NPI Number | 1700359114
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Entity Type | Organization
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Legal Business Name | VIBRANT HEALTHY LIVING & WELLNESS LLC
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Dates
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Enumeration Date | 01/08/2019
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Last Update Date | 01/08/2019
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Provider Practice Location Address
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Address Line | 2600 S LOOP W STE 561
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City | HOUSTON
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State | TX
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Zip | 77054-2653
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Country | US
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Telephone | 281-898-7300
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Fax |
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Provider Business Mailing Address
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Address Line | 2600 S LOOP W STE 561
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City | HOUSTON
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State | TX
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Zip | 77054-2653
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Country | US
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Telephone | 281-898-7300
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JANICE LEONARD
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Credential |
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Telephone | 281-898-7300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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