Provider Demographics
NPI:1043889595
Name:CGL WELLNESS GROUP
Entity type:Organization
Organization Name:CGL WELLNESS GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:REBEKA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:313-247-8840
Mailing Address - Street 1:P.O BOX 40522
Mailing Address - Street 2:12245 BEECH DALY RD.
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48239
Mailing Address - Country:US
Mailing Address - Phone:313-247-8850
Mailing Address - Fax:
Practice Address - Street 1:8435 CEDAR MDWS
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78254-6285
Practice Address - Country:US
Practice Address - Phone:210-742-7123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-20
Last Update Date:2021-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty