# ADULT & GERIATRIC WHOLISTIC HEALTH LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Adult & Geriatric Wholistic Health LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1205642915
- **Authorized official:** PATRICIA Z MBOLA NP (MANAGER)
- **Authorized official phone:** (832) 908-8136

## Contact information

- **Practice address:** 647 S MARATHON WAY, STAFFORD, TX 77477-5841
- **Practice address phone:** (832) 908-8136
- **Mailing address:** 647 S MARATHON WAY, STAFFORD, TX 77477-5841
- **Mailing address phone:** (832) 908-8136

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LG0600X | Gerontology Nurse Practitioner | — | NULL | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 12/06/2024
- **Last updated:** 12/06/2024