Provider Demographics
| NPI: | 1225641285 |
|---|---|
| Name: | CENTER TO RISE WELLNESS SPA STUDIO |
| Entity type: | Organization |
| Organization Name: | CENTER TO RISE WELLNESS SPA STUDIO |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | CHIEF EXECUTIVE OFFICER |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | NICOLE |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | BUTLER |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | LMSW, LCDC-I |
| Authorized Official - Phone: | 817-987-2651 |
| Mailing Address - Street 1: | 600 W PARK ROW DR STE A |
| Mailing Address - Street 2: | |
| Mailing Address - City: | ARLINGTON |
| Mailing Address - State: | TX |
| Mailing Address - Zip Code: | 76010-2559 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 817-987-2651 |
| Mailing Address - Fax: | 214-602-6638 |
| Practice Address - Street 1: | 600 W PARK ROW DR STE A |
| Practice Address - Street 2: | |
| Practice Address - City: | ARLINGTON |
| Practice Address - State: | TX |
| Practice Address - Zip Code: | 76010-2559 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 817-987-2651 |
| Practice Address - Fax: | 214-602-6638 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2020-08-28 |
| Last Update Date: | 2022-01-07 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 332B00000X | Suppliers | Durable Medical Equipment & Medical Supplies | ||
| No | 101Y00000X | Behavioral Health & Social Service Providers | Counselor | Group - Multi-Specialty | |
| No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
| No | 104100000X | Behavioral Health & Social Service Providers | Social Worker | Group - Multi-Specialty | |
| No | 174400000X | Other Service Providers | Specialist | Group - Multi-Specialty | |
| No | 251B00000X | Agencies | Case Management | Group - Multi-Specialty | |
| No | 251S00000X | Agencies | Community/Behavioral Health | Group - Multi-Specialty | |
| No | 261QB0400X | Ambulatory Health Care Facilities | Clinic/Center | Birthing | |
| No | 261QC1500X | Ambulatory Health Care Facilities | Clinic/Center | Community Health | Group - Multi-Specialty |
| No | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | Group - Multi-Specialty |
| No | 261QM0850X | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | Group - Multi-Specialty |
| No | 261QM0855X | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health | |
| No | 261QR0401X | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) | |
| No | 332BC3200X | Suppliers | Durable Medical Equipment & Medical Supplies | Customized Equipment | |
| No | 335E00000X | Suppliers | Prosthetic/Orthotic Supplier |
