Provider Demographics
NPI:1538786090
Name:ESSENTIAL HEALTH & WELLNESS CLINIC P.A.
Entity type:Organization
Organization Name:ESSENTIAL HEALTH & WELLNESS CLINIC P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MURRY
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:662-449-6570
Mailing Address - Street 1:5842 GOODMAN RD STE 1
Mailing Address - Street 2:
Mailing Address - City:HORN LAKE
Mailing Address - State:MS
Mailing Address - Zip Code:38637-8106
Mailing Address - Country:US
Mailing Address - Phone:662-449-6570
Mailing Address - Fax:662-510-8586
Practice Address - Street 1:5842 GOODMAN RD STE 1
Practice Address - Street 2:
Practice Address - City:HORN LAKE
Practice Address - State:MS
Practice Address - Zip Code:38637-8106
Practice Address - Country:US
Practice Address - Phone:662-449-6570
Practice Address - Fax:662-510-8586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-01
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service