Provider Demographics
| NPI: | 1093491243 |
|---|---|
| Name: | LONGVIEW WELLNESS CENTER INC |
| Entity type: | Organization |
| Organization Name: | LONGVIEW WELLNESS CENTER INC |
| Other - Org Name: | <UNAVAIL> |
| Other - Org Type: | |
| Authorized Official - Title/Position: | CEO |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | TIMOTHY |
| Authorized Official - Middle Name: | CHAD |
| Authorized Official - Last Name: | JONES |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 903-758-2610 |
| Mailing Address - Street 1: | 1107 E MARSHALL AVE |
| Mailing Address - Street 2: | |
| Mailing Address - City: | LONGVIEW |
| Mailing Address - State: | TX |
| Mailing Address - Zip Code: | 75601-5602 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 903-758-2610 |
| Mailing Address - Fax: | 903-758-7081 |
| Practice Address - Street 1: | 425 N FREDONIA ST |
| Practice Address - Street 2: | |
| Practice Address - City: | LONGVIEW |
| Practice Address - State: | TX |
| Practice Address - Zip Code: | 75601-6464 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 903-758-2610 |
| Practice Address - Fax: | 903-758-7081 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | Yes |
| Parent Organization LBN: | LONGVIEW WELLNESS CENTER INC |
| Parent Organization TIN: | <UNAVAIL> |
| Enumeration Date: | 2023-06-23 |
| Last Update Date: | 2025-11-13 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 261QF0400X | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) | |
| No | 261QF0050X | Ambulatory Health Care Facilities | Clinic/Center | Family Planning, Non-Surgical | |
| No | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | Clinical | Group - Multi-Specialty |
| No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
| No | 261QA0005X | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Family Planning Facility | |
| No | 363LP0808X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psychiatric/Mental Health | Group - Multi-Specialty |
| No | 261QP2300X | Ambulatory Health Care Facilities | Clinic/Center | Primary Care | |
| No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
| No | 251B00000X | Agencies | Case Management | ||
| No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
| No | 261QR0405X | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder | |
| No | 261QM1300X | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | |
| No | 208D00000X | Allopathic & Osteopathic Physicians | General Practice | Group - Multi-Specialty | |
| No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
| No | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional | Group - Multi-Specialty |
