Provider Demographics
NPI:1821327123
Name:TLC WELLNESS, LLC
Entity Type:Organization
Organization Name:TLC WELLNESS, LLC
Other - Org Name:TLC WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TORY
Authorized Official - Middle Name:
Authorized Official - Last Name:LUCAS
Authorized Official - Suffix:
Authorized Official - Credentials:RN, CCRN, CDE
Authorized Official - Phone:509-863-5618
Mailing Address - Street 1:2226 W COURTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-2513
Mailing Address - Country:US
Mailing Address - Phone:509-863-5618
Mailing Address - Fax:509-456-5433
Practice Address - Street 1:105 W 8TH AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2302
Practice Address - Country:US
Practice Address - Phone:509-863-5618
Practice Address - Fax:509-456-3557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-15
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00138240261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty