Provider Demographics
NPI:1699493676
Name:TELEHEALTH WELLNESS
Entity type:Organization
Organization Name:TELEHEALTH WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:J
Authorized Official - Last Name:GUILLORY
Authorized Official - Suffix:JR
Authorized Official - Credentials:DNP
Authorized Official - Phone:409-877-1773
Mailing Address - Street 1:837 N MAIN ST SPC 118
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:TX
Mailing Address - Zip Code:77657-1018
Mailing Address - Country:US
Mailing Address - Phone:409-877-1773
Mailing Address - Fax:
Practice Address - Street 1:837 N MAIN ST SPC 118
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:TX
Practice Address - Zip Code:77657-1018
Practice Address - Country:US
Practice Address - Phone:409-877-1773
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-16
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care