MEDICARE: BEATITUDES WELLNESS CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	62194	TX

General Provider Information

NPI Number	:	1063660124
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEATITUDES WELLNESS CENTER LLC

Provider Business Mailing Address
First Line	:	PO BOX 841077
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77284-1077
Country	:	US
Telephone Number	:	832-230-4158
Fax Number	:

Provider Business Practice Location Address
First Line	:	16015 CAIRNWAY DR.
Second Line	:	#841077
City	:	HOUSTON
State	:	TX
Zip	:	77284-1077
Country	:	US
Telephone Number	:	832-230-4158
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MRS. PATRICIA JOHNSON
Credential	:	M.A., LPC-S
Telephone Number	:	832-230-4158

Provider Enumeration Date	:	09/03/2008
Last Update Date	:	04/10/2024

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