Provider Demographics
NPI:1720615479
Name:INSTITUTE OF INTEGRATIVE HEALTH SPECIALISTS & HOLISTIC WELLNESS CENTER
Entity Type:Organization
Organization Name:INSTITUTE OF INTEGRATIVE HEALTH SPECIALISTS & HOLISTIC WELLNESS CENTER
Other - Org Name:RACINEE HOLISTIC WELLNESS CENTER, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO & FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:THALIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MICAH
Authorized Official - Suffix:
Authorized Official - Credentials:DACM, LAC, LMT
Authorized Official - Phone:832-382-1825
Mailing Address - Street 1:2950 S GESSNER RD STE 208
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77063-3774
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2950 S GESSNER RD STE 208
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77063-3774
Practice Address - Country:US
Practice Address - Phone:832-382-1825
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-24
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty