The 21 Club of Cny Inc

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

THE 21 CLUB OF CNY INC

Practice address

12828 Willow Centre Dr Ste D
Houston, TX 77066-3043

Phone

(713) 766-2796

Fax

(712) 219-5827

NPI assigned

Jan 6, 2026

Organization subpart

No

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

Authorized official

Name

Carolyn Waldron

Title

Owner

Phone

(713) 766-2796

Specialties & licenses 1

Addresses

Tax ID family

The 21 Club of Cny Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• The 21 Club of Cny Inc

  • Clinical Medical Laboratory
  • Houston, TX
  • NPI 1700743325
  NPD tax ID

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

{
    "created_epoch": "1767657600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1770940800000",
    "number": "1477410090",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12828 WILLOW CENTRE DR STE D",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770663043",
            "telephone_number": "713-766-2796",
            "fax_number": "712-219-5827"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12828 WILLOW CENTRE DR STE D",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770663043",
            "telephone_number": "713-766-2796",
            "fax_number": "712-219-5827"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE 21 CLUB OF CNY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-01-06",
        "last_updated": "2026-02-13",
        "certification_date": "2026-02-13",
        "status": "A",
        "authorized_official_last_name": "WALDRON",
        "authorized_official_first_name": "CAROLYN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "713-766-2796"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• The 21 Club of Cny Inc
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• The Allice Collective for Mental Health & Community Engagement

• Clinical Medical Laboratory in Houston, TX
• Providers in Houston, TX by specialty
• Clinical Medical Laboratory in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.