Provider Demographics
NPI:1972873230
Name:WHOLE WELLNESS, PLLC
Entity Type:Organization
Organization Name:WHOLE WELLNESS, PLLC
Other - Org Name:PAULA VANDYKE, MA, LMFT, LPC
Other - Org Type:Other Name
Authorized Official - Title/Position:LICENSED THERAPIST/COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:VANDYKE
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT LPC
Authorized Official - Phone:281-940-8745
Mailing Address - Street 1:10701 CORPORATE DR
Mailing Address - Street 2:SUITE 393
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-4096
Mailing Address - Country:US
Mailing Address - Phone:281-940-8745
Mailing Address - Fax:
Practice Address - Street 1:10701 CORPORATE DR
Practice Address - Street 2:SUITE 393
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-4096
Practice Address - Country:US
Practice Address - Phone:281-940-8745
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-04
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64964101YM0800X
TX201285106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty