Provider Demographics
NPI:1639061948
Name:COSMIC BODY WELLNESS FELLOWSHIP
Entity type:Organization
Organization Name:COSMIC BODY WELLNESS FELLOWSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER & PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAM
Authorized Official - Middle Name:TRUC
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC, PHD, CCHT, LRT
Authorized Official - Phone:479-226-2002
Mailing Address - Street 1:PO BOX 3135
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-7711
Mailing Address - Country:US
Mailing Address - Phone:479-226-2002
Mailing Address - Fax:
Practice Address - Street 1:7 WOODLAND PL
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72904-2564
Practice Address - Country:US
Practice Address - Phone:479-226-2002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-21
Last Update Date:2025-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282J00000XHospitalsReligious Nonmedical Health Care Institution
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No251V00000XAgenciesVoluntary or Charitable