Provider Demographics
NPI:1346016524
Name:HEALTHY LICE REMOVAL
Entity Type:Organization
Organization Name:HEALTHY LICE REMOVAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICE TECHNICIAN
Authorized Official - Prefix:
Authorized Official - First Name:CLARISA
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-205-8055
Mailing Address - Street 1:6906 LUCERO CT
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-1877
Mailing Address - Country:US
Mailing Address - Phone:956-205-8055
Mailing Address - Fax:
Practice Address - Street 1:6906 LUCERO CT
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572
Practice Address - Country:US
Practice Address - Phone:956-205-8055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-29
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171400000XOther Service ProvidersHealth & Wellness CoachGroup - Single Specialty