Provider Demographics
NPI:1609100031
Name:WELLNESS WILLOWS HOLISTIC HEALTH RETREAT INC
Entity Type:Organization
Organization Name:WELLNESS WILLOWS HOLISTIC HEALTH RETREAT INC
Other - Org Name:WELLNESS WILLOWS SLEEPQUIP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FACILITY DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MURRAY-WACHTEDORF
Authorized Official - Suffix:I
Authorized Official - Credentials:PSYD, LPC
Authorized Official - Phone:936-931-3324
Mailing Address - Street 1:16445 MATHIS RD
Mailing Address - Street 2:
Mailing Address - City:WALLER
Mailing Address - State:TX
Mailing Address - Zip Code:77484-5397
Mailing Address - Country:US
Mailing Address - Phone:936-931-3324
Mailing Address - Fax:832-553-7973
Practice Address - Street 1:16445 MATHIS RD
Practice Address - Street 2:
Practice Address - City:WALLER
Practice Address - State:TX
Practice Address - Zip Code:77484-5397
Practice Address - Country:US
Practice Address - Phone:936-931-3324
Practice Address - Fax:832-553-7973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-02
Last Update Date:2009-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies