Provider Demographics
NPI:1679899546
Name:WELLNESS COUNSELING CENTER OF TEXAS, LLC
Entity type:Organization
Organization Name:WELLNESS COUNSELING CENTER OF TEXAS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MONTAGUE
Authorized Official - Middle Name:
Authorized Official - Last Name:SPEARMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-501-6472
Mailing Address - Street 1:2656 S LOOP W
Mailing Address - Street 2:390
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-2664
Mailing Address - Country:US
Mailing Address - Phone:713-568-9506
Mailing Address - Fax:713-588-2390
Practice Address - Street 1:2656 S LOOP W
Practice Address - Street 2:390
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-2664
Practice Address - Country:US
Practice Address - Phone:713-568-9506
Practice Address - Fax:713-588-2390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-15
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX216126701Medicaid