Provider Demographics
NPI:1871799858
Name:WELLNESS CLINICAL SERVICES INC.
Entity type:Organization
Organization Name:WELLNESS CLINICAL SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:LANG
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:505-753-5811
Mailing Address - Street 1:721 BOND ST
Mailing Address - Street 2:
Mailing Address - City:ESPANOLA
Mailing Address - State:NM
Mailing Address - Zip Code:87532-2729
Mailing Address - Country:US
Mailing Address - Phone:505-753-5811
Mailing Address - Fax:505-747-3210
Practice Address - Street 1:721 BOND ST
Practice Address - Street 2:
Practice Address - City:ESPANOLA
Practice Address - State:NM
Practice Address - Zip Code:87532-2729
Practice Address - Country:US
Practice Address - Phone:505-753-5811
Practice Address - Fax:505-747-3210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0318251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health