MEDICARE: WELLNESS AND HOLISTIC CONCIERGE PRACTICE PROFESSIONAL CORPORATION

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1598485864
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELLNESS AND HOLISTIC CONCIERGE PRACTICE PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	111 MORGAN AVE APT 1028
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75203-1014
Country	:	US
Telephone Number	:	682-461-9037
Fax Number	:	860-370-4109

Provider Business Practice Location Address
First Line	:	111 MORGAN AVE APT 1028
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75203-1014
Country	:	US
Telephone Number	:	682-461-9037
Fax Number	:	860-370-4109

Authorized Official
Title or Position	:	OWNER
Name	:	MARIA DE LA ALHAMBRA PEREZ-FERNANDEZ
Credential	:	LMHC, LPC, LPCC
Telephone Number	:	682-461-9037

Provider Enumeration Date	:	08/29/2022
Last Update Date	:	03/29/2025

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