=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902683139
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WHOLEMIND WELLNESS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/12/2023
-----------------------------------------------------
Last Update Date | 10/10/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7602 WESTWIND LN
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77071-1421
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-859-0268
-----------------------------------------------------
Fax | 832-565-8555
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7602 WESTWIND LN
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77071-1421
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-859-0268
-----------------------------------------------------
Fax | 832-565-8555
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MRS. CHIOMA NWOKORO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 832-859-0268
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------