Provider Demographics
NPI:1972134229
Name:CLEAR LAKE INTEGRATIVE MEDICINE
Entity Type:Organization
Organization Name:CLEAR LAKE INTEGRATIVE MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:RACHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDRIKZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-425-2524
Mailing Address - Street 1:1335 REGENTS PARK DR STE 110
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-2541
Mailing Address - Country:US
Mailing Address - Phone:713-425-2524
Mailing Address - Fax:281-783-2318
Practice Address - Street 1:1335 REGENTS PARK DR STE 110
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-2541
Practice Address - Country:US
Practice Address - Phone:713-425-2524
Practice Address - Fax:281-783-2318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-27
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty