Provider Demographics
NPI:1861172504
Name:SELF WELLNESS THERAPEUTIC CENTER LLC
Entity type:Organization
Organization Name:SELF WELLNESS THERAPEUTIC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WING
Authorized Official - Middle Name:
Authorized Official - Last Name:TSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-772-0300
Mailing Address - Street 1:7001 CORPORATE DR STE 213A
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-5116
Mailing Address - Country:US
Mailing Address - Phone:713-772-0300
Mailing Address - Fax:
Practice Address - Street 1:7001 CORPORATE DR STE 213A
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-5116
Practice Address - Country:US
Practice Address - Phone:713-772-0300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-18
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service