Provider Demographics
NPI:1407511082
Name:WELLNESS MAGNIFICENCE PSYCHOTHERAPY & CONSULTING, LLC
Entity Type:Organization
Organization Name:WELLNESS MAGNIFICENCE PSYCHOTHERAPY & CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KERVIL
Authorized Official - Middle Name:
Authorized Official - Last Name:DURAND
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LCDC
Authorized Official - Phone:832-590-9779
Mailing Address - Street 1:PO BOX 3042
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77588-3042
Mailing Address - Country:US
Mailing Address - Phone:832-590-9779
Mailing Address - Fax:
Practice Address - Street 1:5850 SAN FELIPE ST STE 500
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-8003
Practice Address - Country:US
Practice Address - Phone:832-590-9779
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-08
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty