Provider Demographics
NPI:1811554728
Name:ANCIENT WISDOM HOLISTIC WELLNESS CENTER
Entity Type:Organization
Organization Name:ANCIENT WISDOM HOLISTIC WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:CLAY
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:346-277-5938
Mailing Address - Street 1:5901 SELINSKY RD APT 44
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77048-1930
Mailing Address - Country:US
Mailing Address - Phone:346-291-8232
Mailing Address - Fax:
Practice Address - Street 1:5901 SELINSKY RD APT 44
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77048-1930
Practice Address - Country:US
Practice Address - Phone:346-291-8232
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-27
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No173C00000XOther Service ProvidersReflexologistGroup - Multi-Specialty
No374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty