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General NPI Number Information
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NPI Number | 1992438717
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Entity Type | Organization
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Legal Business Name | GENESIS HEALTH AND WELLNESS CLINIC &SPA, PLLC
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Dates
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Enumeration Date | 07/08/2022
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Last Update Date | 07/08/2022
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Provider Practice Location Address
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Address Line | 525 N SAM HOUSTON PKWY E STE 255
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City | HOUSTON
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State | TX
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Zip | 77060-4017
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Country | US
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Telephone | 832-672-4739
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Fax | 832-575-4999
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Provider Business Mailing Address
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Address Line | 525 N SAM HOUSTON PKWY E STE 255
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City | HOUSTON
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State | TX
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Zip | 77060-4017
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SANDRA NORRIS- DECKARD
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Credential | NP-C
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Telephone | 832-672-4739
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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 | 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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Taxonomy #3
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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