Provider Demographics
NPI:1992151427
Name:SUGAR N SPICE TOTAL BODY WELLNESS SPA
Entity type:Organization
Organization Name:SUGAR N SPICE TOTAL BODY WELLNESS SPA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HUMAN RESOURCE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-915-0326
Mailing Address - Street 1:310 NORTH MAIN STREET
Mailing Address - Street 2:SUITE C-1
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248
Mailing Address - Country:US
Mailing Address - Phone:817-823-0354
Mailing Address - Fax:
Practice Address - Street 1:310 NORTH MAIN STREET
Practice Address - Street 2:SUITE C-1
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248
Practice Address - Country:US
Practice Address - Phone:817-823-0354
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-13
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3331101Y00000X, 101YA0400X, 101YM0800X, 171M00000X
TX10641101Y00000X, 101YA0400X, 101YM0800X, 171M00000X
TX129313171M00000X
TXMT040632172M00000X, 173C00000X
TXMT121107172M00000X, 173C00000X
TXMT121751172M00000X, 173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172M00000XOther Service ProvidersMechanotherapistGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No173C00000XOther Service ProvidersReflexologistGroup - Multi-Specialty