Provider Demographics
NPI:1972188605
Name:NG WELLNESS
Entity Type:Organization
Organization Name:NG WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:NATALIE
Authorized Official - Last Name:GALLEGOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-645-1764
Mailing Address - Street 1:1531 DOUGLAS ST
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84404-6830
Mailing Address - Country:US
Mailing Address - Phone:801-645-1763
Mailing Address - Fax:
Practice Address - Street 1:1531 DOUGLAS ST
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84404-6830
Practice Address - Country:US
Practice Address - Phone:180-164-5176
Practice Address - Fax:801-675-5305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-15
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health