Provider Demographics
NPI:1891462438
Name:DELUXE MIND & BODY MEDICAL SPA LLC
Entity Type:Organization
Organization Name:DELUXE MIND & BODY MEDICAL SPA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ODIRI
Authorized Official - Middle Name:
Authorized Official - Last Name:AKUSHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-584-4092
Mailing Address - Street 1:1727 LAKE CHARLOTTE LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77406-8096
Mailing Address - Country:US
Mailing Address - Phone:832-584-4092
Mailing Address - Fax:
Practice Address - Street 1:6214 PRESIDIO CANYON DR
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-8756
Practice Address - Country:US
Practice Address - Phone:832-584-4092
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-23
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty