Provider Demographics
NPI:1679183966
Name:GOLDEN LIFE CLINIC WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:GOLDEN LIFE CLINIC WELLNESS CENTER, LLC
Other - Org Name:GLC WELLNESS CENTER LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:NASHAYE
Authorized Official - Last Name:RICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:346-334-0588
Mailing Address - Street 1:18919 AYSTON DR
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-2001
Mailing Address - Country:US
Mailing Address - Phone:971-506-1996
Mailing Address - Fax:
Practice Address - Street 1:18919 AYSTON DR
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-2001
Practice Address - Country:US
Practice Address - Phone:971-506-1996
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-03
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty