Provider Demographics
NPI:1760102495
Name:MY HEALING CENTER OF SOUTH TEXAS PLLC
Entity Type:Organization
Organization Name:MY HEALING CENTER OF SOUTH TEXAS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-FOUNDER/CO-CEO
Authorized Official - Prefix:
Authorized Official - First Name:MELICA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILEY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LMFT
Authorized Official - Phone:913-683-4757
Mailing Address - Street 1:433 S TANCAHUA ST
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78401-3422
Mailing Address - Country:US
Mailing Address - Phone:361-585-4664
Mailing Address - Fax:
Practice Address - Street 1:433 S TANCAHUA ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78401-3422
Practice Address - Country:US
Practice Address - Phone:361-585-4664
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-01
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)