Deer Lake Lodge, LLC

Primary specialty

NutritionistTaxonomy code 133N00000X

Legal business name

DEER LAKE LODGE, LLC

Practice address

10500 Deer Lake Lodge Rd
Montgomery, TX 77316-9604

Phone

(281) 414-5111

NPI assigned

Jan 8, 2022

Organization subpart

No

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

Authorized official

Name

Tracy Boulware

Title

Spa & Wellness Director

Phone

(281) 414-5111

Specialties & licenses 1

Addresses

Other names 1

• Organic Investments, llc Former legal business name

Electronic endpoints 1

Locations

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

{
    "created_epoch": "1641600000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1641600000000",
    "number": "1922769231",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 70709",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "772700709",
            "telephone_number": "281-414-5111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10500 DEER LAKE LODGE RD",
            "city": "MONTGOMERY",
            "state": "TX",
            "postal_code": "773169604",
            "telephone_number": "281-414-5111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEER LAKE LODGE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-08",
        "last_updated": "2022-01-08",
        "certification_date": "2021-12-21",
        "status": "A",
        "authorized_official_last_name": "BOULWARE",
        "authorized_official_first_name": "TRACY",
        "authorized_official_title_or_position": "SPA & WELLNESS DIRECTOR",
        "authorized_official_telephone_number": "281-414-5111"
    },
    "taxonomies": [
        {
            "code": "133N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nutritionist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "chris@fisherlane.net",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "10500 Deer Lake Lodge Rd",
            "city": "Montgomery",
            "state": "TX",
            "country_code": "US",
            "postal_code": "773169604",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Organic Investments, llc",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Bradley Davis
• Jane Davis, PT, MSHP
• Mia Davis, LMT
• Kristin De Meo, M.S. CCC-SLP
• Amy R Dean, LMFT
• Dental Health Associates of Texas, PC (Stewart Creek Dental Care)
• Dentists of Montgomery, PC (Dentists of Montgomery)
• Tony Wesley Deramus, DC
• Erika Dichmann, PT, DPT
• Billie Christine Dickens, COTA/L

• Nutritionist in Montgomery, TX
• Providers in Montgomery, TX by specialty
• Nutritionist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 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.