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General NPI Number Information
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NPI Number | 1972873230
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Entity Type | Organization
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Legal Business Name | WHOLE WELLNESS, PLLC
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Dates
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Enumeration Date | 01/04/2012
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Last Update Date | 01/04/2012
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Provider Practice Location Address
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Address Line | 10701 CORPORATE DR SUITE 393
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City | STAFFORD
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State | TX
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Zip | 77477-4096
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Country | US
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Telephone | 281-940-8745
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Fax |
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Provider Business Mailing Address
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Address Line | 10701 CORPORATE DR SUITE 393
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City | STAFFORD
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State | TX
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Zip | 77477-4096
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Country | US
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Telephone | 281-940-8745
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Fax |
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Authorized Official
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Title or Position | LICENSED THERAPIST/COUNSELOR
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Name | PAULA VANDYKE
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Credential | LMFT LPC
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Telephone | 281-940-8745
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 201285
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 64964
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License Number State | TX
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