NPIMap

Organization Active NPI

Longview Wellness Center Inc

  • Federally Qualified Health Center (FQHC)
  • Longview, TX
National Provider Identifier
1417779554
Registry record updated Nov 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
LONGVIEW WELLNESS CENTER INC
Practice address
1011 S Mobberly Ave
Longview, TX 75602-2041
Phone
(903) 758-2610
Fax
(903) 758-7081
NPI assigned
Oct 29, 2024
Organization subpart
Yes
Parent organization
LONGVIEW WELLNESS CENTER INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 14, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Timothy Chad Jones
Title
Ceo
Phone
(903) 758-2610

Specialties & licenses 14

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X
Case Manager/Care CoordinatorGroup: 193200000X MULTI-SPECIALTY GROUP 171M00000X
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Obstetrics & Gynecology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207V00000X
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X
Case Management Agency 251B00000X
Ambulatory Family Planning Facility 261QA0005X
Non-Surgical Family Planning Clinic/Center 261QF0050X
Federally Qualified Health Center (FQHC) 261QF0400X Primary
Multi-Specialty Clinic/Center 261QM1300X
Primary Care Clinic/Center 261QP2300X

Addresses

Primary practice location

1011 S Mobberly Ave
Longview, TX 75602-2041

Mailing address

1107 E Marshall Ave
Longview, TX 75601-5602
Phone (903) 758-2610

Other names 1

  • Wellness Pointe Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050714001046 TX Part B Supplier - Clinic/Group Practice 1254367766 Receives reassigned benefits from 130 practitioners
27 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Longview, TX; Mount Pleasant, TX; Tyler, TX; Gilmer, TX; Kilgore, TX
O20250909003505 TX Part A Provider - Federally Qualified Health Center (FQHC) 1254367766 Practice locations: Longview, TX

Federally qualified health center certification: CCN 971079

Legal name
LONGVIEW WELLNESS CENTER INC
Doing business as
WELLNESS POINTE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 12, 2025
Last certification
Aug 12, 2025
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
1011 S Mobberly Ave
Longview, TX 75602-2041

Other NPIs with the same Medicare PAC ID 16

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 16

Other NPIs on the same Medicare enrollment 27

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 27

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
45D2313388Longview Wellness Center Inc1011 S Mobberly Ave, Longview, TX 75602Certificate of waiverOct 29, 2026

National Provider Directory

National Provider Directory
Tax ID family
Longview Wellness Center Inc28 organizations share this tax ID, including this one
Part of
Longview Wellness Center Inc

Other organizations with this tax ID 27

Organizations that report the same tax identification number in the National Provider Directory.

View all 27

Ownership & related parties

All disclosed owners & managing parties 16

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
William Womack Individual Corporate OfficerCoco May 16, 2024 100%
W-2 Managing EmployeeCoco May 16, 2024 100%
Terrie Mogavero Individual W-2 Managing EmployeeCredentialing Analyst Nov 19, 2012 100%
Allen Lizza Individual Corporate DirectorBoard Member Jan 1, 2023 100%
Francisco Rojas Individual Corporate DirectorBoard Director Jun 20, 2024 100%
Berenda Mathis Individual Corporate DirectorBoard Member Jan 1, 2023 100%
Anthony Brooks Individual Corporate DirectorBoard Member Mar 1, 2022 100%
Rosita Peralta Individual Corporate DirectorDirector of Operations May 16, 2024 100%
W-2 Managing EmployeeDirector of Operations May 16, 2024 100%
Timothy C Jones Individual Corporate OfficerCeo Oct 13, 2013 100%
W-2 Managing EmployeeCeo Oct 13, 2013 100%
Ingrid Self Individual Corporate DirectorBoard Member Jan 1, 2022 100%
Mary a Hagenbucher Individual Corporate DirectorBoard Member Jan 1, 2022 100%
Susan B Warford Individual Corporate OfficerCfo Jun 16, 2018 100%
W-2 Managing EmployeeCfo Jun 16, 2018 100%
Kent Phillips Individual Corporate DirectorBoard Member Jun 18, 2019 100%
Brad Osburg Individual Corporate DirectorBoard Member Jan 1, 2020 100%
Matt Tooker Individual Corporate DirectorBoard Member Jan 1, 2022 100%
Donna Habinc Individual Corporate DirectorBoard Member Jan 16, 2020 100%
Valerie Baxter Individual Corporate DirectorBoard Member Jan 1, 2022 100%

All facility ownership & control disclosures 10

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Wellness PointeKilgore, TX, CCN 671962 Federally qualified health center 5% Or Greater Indirect Ownership Interest (100%)
Operational/Managerial Control (100%)		 Aug 6, 2013
Aug 6, 2013
Wellness PointeLongview, TX, CCN 741867 Federally qualified health center Operational/Managerial Control (100%) Aug 6, 2013
Wellness PointeLongview, TX, CCN 741884 Federally qualified health center Operational/Managerial Control (100%) Aug 6, 2013
Wellness PointeLongview, TX, CCN 451113 Federally qualified health center 5% Or Greater Indirect Ownership Interest (100%)
Operational/Managerial Control (100%)		 Aug 6, 2013
Aug 6, 2013
Wellness PointeTyler, TX, CCN 451151 Federally qualified health center 5% Or Greater Indirect Ownership Interest (100%)
Operational/Managerial Control (100%)		 Aug 6, 2013
Feb 1, 2021
Wellness PointeLongview, TX, CCN 451179 Federally qualified health center Operational/Managerial Control (100%) Jan 4, 2022
Longview Wellness Center IncLongview, TX, CCN 671106 Federally qualified health center Operational/Managerial Control (100%) Aug 21, 2023
Wellness PointeLongview, TX, CCN 671198 Federally qualified health center Operational/Managerial Control (100%) Aug 6, 2013
Wellness PointeLongview, TX, CCN 971076 Federally qualified health center Operational/Managerial Control (100%) Apr 11, 2025
Wellness PointeLongview, TX, CCN 971073 Federally qualified health center Operational/Managerial Control (100%) Apr 11, 2025

Owned or controlled facilities with NPI records 10

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 25

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 25

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1730160000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1763078400000",
    "number": "1417779554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1107 E MARSHALL AVE",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756015602",
            "telephone_number": "903-758-2610",
            "fax_number": "903-758-7081"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1011 S MOBBERLY AVE",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756022041",
            "telephone_number": "903-758-2610",
            "fax_number": "903-758-7081"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LONGVIEW WELLNESS CENTER INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LONGVIEW WELLNESS CENTER INC",
        "enumeration_date": "2024-10-29",
        "last_updated": "2025-11-14",
        "certification_date": "2025-11-14",
        "status": "A",
        "authorized_official_last_name": "JONES",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "CHAD",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "903-758-2610"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QA0005X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Family Planning Facility",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0050X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Family Planning, Non-Surgical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wellness Pointe",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Longview, TX

Sources for this page

Verify at the official NPI Registry.