Provider Demographics
NPI:1578228383
Name:AMAZINGFAVOR WELLNESS CENTER PLLC
Entity Type:Organization
Organization Name:AMAZINGFAVOR WELLNESS CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP
Authorized Official - Prefix:MISS
Authorized Official - First Name:ELSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:NLERUM
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:832-848-1730
Mailing Address - Street 1:3907 BRIDGEBAY LN
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449-3895
Mailing Address - Country:US
Mailing Address - Phone:832-848-1730
Mailing Address - Fax:
Practice Address - Street 1:3907 BRIDGEBAY LN
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449-3895
Practice Address - Country:US
Practice Address - Phone:832-848-1730
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-05
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health