Organization
GLC WELLNESS CENTER TEXAS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANTE YOUNG (CEO)
(702) 587-8106
Entity
Organization
Contact information
Practice address
777 E WHEATLAND RD STE 106, DUNCANVILLE, TX 75116-4918
(702) 587-8106
(972) 685-5108
Mailing address
777 E WHEATLAND RD STE 106, DUNCANVILLE, TX 75116-4918
(702) 587-8106
(972) 685-5108
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
208D00000X
General Practice Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
405039501
—
TX
05
—
405039502
—
TX
05
—
405039504
—
TX
05
—
455039503
—
TX
Enumeration date
08/23/2019
Last updated
06/30/2023
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