GLC Wellness Center Texas LLC
Organization Active NPI General Practice Physician · Duncanville, TX
NPI 1700433653 · NPPES record last updated Jun 30, 2023
Key facts
- NPI
- 1700433653
- Entity type
- Organization (NPI type 2)
- Primary specialty
- General Practice Physician 208D00000X
- Legal business name
- GLC WELLNESS CENTER TEXAS LLC
- Practice address
- 777 E Wheatland Rd Ste 106
Duncanville, TX 75116-4918 - Phone
- (702) 587-8106
- Fax
- (972) 685-5108
- NPI assigned
- Aug 23, 2019
- Organization subpart
- No
Authorized official
- Name
- Dante Young
- Title
- Ceo
- Phone
- (702) 587-8106
Practitioners 24
-
Tenesia Nicole Moore, APRN, FNP-C
-
Angelica Torres Yrigollen, FNP-BC
-
Dennis Rahim Abbas, M.D.
-
Shola Philip Akinfiresoye, DNP, FNP-BC
-
Kristina M Byrd-Joseph, LCSW
-
Valarie Denise Crawford, APRN
-
Tricia Davis, LCSW
-
Edward Galvan, NP
-
Jeffrey Carl Patterson, D.O.
-
Murray Robert Strauss, M.D.
-
Mofoluwasho Adenekan, FNP
-
Monnie E Adereti, FNP
-
Karen D Carroll, FNP
-
Gibson Ann Hernandez, RN, AGPCNP-BC
-
Benjamin Perez-Ruiz, AGNP-C
-
Roy A Setzenfand, MD
-
Victorine Tebong, FNP-C
-
Tracy E Walker, LISW
-
Zenobia L Newman, FNP-BC
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 45D2282762 | GLC Wellness Center Texas LLC | Certificate of waiver | May 24, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20200310002430 | TX | Part B Supplier - Clinic/Group Practice | 0143658906 |
Receives reassigned benefits from 12 practitioners Practice locations: Duncanville, TX |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor |
101YM0800X | |||
| General Practice Physician |
208D00000X | Yes |
Addresses
Primary practice location
777 E Wheatland Rd Ste 106
Duncanville, TX 75116-4918
Mailing address
777 E Wheatland Rd Ste 106
Duncanville, TX 75116-4918
Phone (702) 587-8106
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 405039501 | Medicaid | TX | |
| 455039503 | Medicaid | TX | |
| 405039504 | Medicaid | TX | |
| 405039502 | Medicaid | TX |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | WWW.GLCWELLNESS.COM | Direct |
Other providers in Duncanville, TX
- Travicia Lacole Garrett
- Ann Wanjiru Gathura
- Diane Barnes Gawedzinski
- Geneye Inc.
- Helen D Gipson
- Glennwood Enterprises, Inc
- Glory Able Home Healthcare Inc
- Glory Financial Services
- Ebony Goggins
- Golden Gate Adult Day Care
All providers in Duncanville, TX · General Practice Physician in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 30, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.