=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972477453
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INCLUSIVE MENTAL WELLNESS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/30/2025
-----------------------------------------------------
Last Update Date | 10/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1823 STADIUM DRIVE #508
-----------------------------------------------------
City | WHARTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77488
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-501-9583
-----------------------------------------------------
Fax | 281-783-2643
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9115 FM 723 RD STE 550 PMB 1071
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77406
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-501-9853
-----------------------------------------------------
Fax | 281-783-2643
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OPERATIONAL DIRECTOR
-----------------------------------------------------
Name | ELYSHA IWUEKE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 713-804-9035
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 172V00000X
-----------------------------------------------------
Taxonomy Name | Community Health Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #6
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #7
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------