MEDICARE: ART AND HEALING 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

General Provider Information

NPI Number	:	1992576656
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ART AND HEALING WELLNESS CENTER, LLC

Provider Business Mailing Address
First Line	:	1314 W SAINT CHARLES ST
Second Line	:
City	:	BROWNSVILLE
State	:	TX
Zip	:	78520-6504
Country	:	US
Telephone Number	:	956-639-7172
Fax Number	:

Provider Business Practice Location Address
First Line	:	880 RIDGEWOOD ST STE 4
Second Line	:
City	:	BROWNSVILLE
State	:	TX
Zip	:	78520-8466
Country	:	US
Telephone Number	:	210-675-0066
Fax Number	:	210-675-0066

Authorized Official
Title or Position	:	OFFICE AND BILLING MANAGER
Name	:	MR. DANIEL VIDAURRI
Credential	:
Telephone Number	:	210-675-0066

Provider Enumeration Date	:	01/11/2024
Last Update Date	:	01/11/2024

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