Ketamine Wellness Centers Houston

Primary specialty

Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X

Legal business name

KETAMINE WELLNESS CENTERS HOUSTON

Doing business as

Ketamine Wellness Centers

Practice address

12807 Haynes Rd Unit 1
Houston, TX 77066-1124

Phone

(855) 538-9355

Fax

(844) 538-9355

NPI assigned

Sep 16, 2020

Organization subpart

Yes

Parent organization

KETAMINE WELLNESS CENTERS ARIZONA LLCAs reported in NPPES

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

Authorized official

Name

Ms. Anita Jerger

Title

Executive Assistant

Phone

(855) 538-9355

Specialties & licenses 6

Addresses

Other names 1

• Ketamine Wellness Centers Doing business as

Part of

Ketamine Wellness Centers Arizona LLC

Locations

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

{
    "created_epoch": "1600214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660694400000",
    "number": "1861008831",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12807 HAYNES RD UNIT 1",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770661124",
            "telephone_number": "855-538-9355",
            "fax_number": "844-538-9355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12807 HAYNES RD UNIT 1",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770661124",
            "telephone_number": "855-538-9355",
            "fax_number": "844-538-9355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KETAMINE WELLNESS CENTERS HOUSTON",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KETAMINE WELLNESS CENTERS ARIZONA LLC",
        "enumeration_date": "2020-09-16",
        "last_updated": "2022-08-17",
        "certification_date": "2022-08-17",
        "status": "A",
        "authorized_official_last_name": "JERGER",
        "authorized_official_first_name": "ANITA",
        "authorized_official_title_or_position": "EXECUTIVE ASSISTANT",
        "authorized_official_telephone_number": "855-538-9355",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ketamine Wellness Centers",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Ketamine Wellness Centers",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Pain Medicine (Anesthesiology) Physician in Houston, TX
• Providers in Houston, TX by specialty
• Pain Medicine (Anesthesiology) Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2022; 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.