Provider Demographics
NPI:1720862469
Name:FLOURISH WELLNESS
Entity Type:Organization
Organization Name:FLOURISH WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND LPC
Authorized Official - Prefix:
Authorized Official - First Name:GABRIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:EMORY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, CEDS
Authorized Official - Phone:918-520-3199
Mailing Address - Street 1:2139 E 21ST ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74114-1409
Mailing Address - Country:US
Mailing Address - Phone:918-520-3199
Mailing Address - Fax:918-942-9423
Practice Address - Street 1:2139 E 21ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74114-1409
Practice Address - Country:US
Practice Address - Phone:918-520-3199
Practice Address - Fax:918-942-9423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-23
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center