Provider Demographics
NPI:1073907861
Name:ESSENTIAL WELLNESS PLACE
Entity Type:Organization
Organization Name:ESSENTIAL WELLNESS PLACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JILLAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:DIFRANCESCA
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:361-230-3308
Mailing Address - Street 1:PO BOX 322
Mailing Address - Street 2:
Mailing Address - City:BISHOP
Mailing Address - State:TX
Mailing Address - Zip Code:78343-0322
Mailing Address - Country:US
Mailing Address - Phone:361-248-8279
Mailing Address - Fax:
Practice Address - Street 1:301 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BISHOP
Practice Address - State:TX
Practice Address - Zip Code:78343-2502
Practice Address - Country:US
Practice Address - Phone:361-248-8279
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-19
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70717101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty