Provider Demographics
NPI:1598490815
Name:RESILIENT WELLNESS OF TEXAS LLC
Entity Type:Organization
Organization Name:RESILIENT WELLNESS OF TEXAS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:KLASEY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:562-704-8468
Mailing Address - Street 1:3225 MCLEOD DR
Mailing Address - Street 2:STE 100
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121
Mailing Address - Country:US
Mailing Address - Phone:562-704-8468
Mailing Address - Fax:
Practice Address - Street 1:5343 KIAM ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77007-1216
Practice Address - Country:US
Practice Address - Phone:562-704-8468
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-20
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health