Provider Demographics
NPI:1598301715
Name:CONCIERGE COUNSELING AND WELLNESS, LLC
Entity Type:Organization
Organization Name:CONCIERGE COUNSELING AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER MANAGER OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:JD, LPC-S
Authorized Official - Phone:832-942-8078
Mailing Address - Street 1:5233 BELLAIRE BLVD # 343
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-3901
Mailing Address - Country:US
Mailing Address - Phone:832-942-8078
Mailing Address - Fax:713-434-1413
Practice Address - Street 1:7332 SW FREEWAY
Practice Address - Street 2:#2010
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074
Practice Address - Country:US
Practice Address - Phone:832-942-8078
Practice Address - Fax:713-434-1413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-22
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX216401401Medicaid
1689983231OtherNPPES