Provider Demographics
NPI:1992438717
Name:GENESIS HEALTH AND WELLNESS CLINIC &SPA, PLLC
Entity type:Organization
Organization Name:GENESIS HEALTH AND WELLNESS CLINIC &SPA, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:NORRIS- DECKARD
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:832-672-4739
Mailing Address - Street 1:525 N SAM HOUSTON PKWY E STE 255
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77060-4017
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:525 N SAM HOUSTON PKWY E STE 255
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77060-4017
Practice Address - Country:US
Practice Address - Phone:832-672-4739
Practice Address - Fax:832-575-4999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-08
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Multi-Specialty