Provider Demographics
NPI:1285476531
Name:AG WELLNESS CENTER, PLLC
Entity type:Organization
Organization Name:AG WELLNESS CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELICA
Authorized Official - Middle Name:
Authorized Official - Last Name:GUERRERO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:806-407-0627
Mailing Address - Street 1:4848 LEMMON AVE STE 100
Mailing Address - Street 2:803
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219
Mailing Address - Country:US
Mailing Address - Phone:682-302-1084
Mailing Address - Fax:
Practice Address - Street 1:4848 LEMMON AVE STE 100
Practice Address - Street 2:803
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219
Practice Address - Country:US
Practice Address - Phone:682-302-1084
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-08
Last Update Date:2024-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty