Provider Demographics
NPI:1073935227
Name:OPTIMAL HEALTH AND WELLNESS, LLC
Entity Type:Organization
Organization Name:OPTIMAL HEALTH AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/NP
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:WHNP
Authorized Official - Phone:512-343-3665
Mailing Address - Street 1:9442 N CAPITAL OF TEXAS HWY
Mailing Address - Street 2:ARBORETUM PLAZA ONE, SUITE 500
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-7262
Mailing Address - Country:US
Mailing Address - Phone:512-343-3665
Mailing Address - Fax:855-791-0415
Practice Address - Street 1:9442 N CAPITAL OF TEXAS HWY
Practice Address - Street 2:ARBORETUM PLAZA ONE, SUITE 500
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-7262
Practice Address - Country:US
Practice Address - Phone:512-343-3665
Practice Address - Fax:855-791-0415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-07
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX608462261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service