1265879092 NPI number — LIFE BEGINS ANEW COUNSELING AND CONSULTING

Table of content: (NPI 1265879092)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265879092 NPI number — LIFE BEGINS ANEW COUNSELING AND CONSULTING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIFE BEGINS ANEW COUNSELING AND CONSULTING
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265879092
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/07/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3740 COLONY DR.
Provider Second Line Business Mailing Address:
SUITE 122
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78230-2234
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-846-1091
Provider Business Mailing Address Fax Number:
210-541-0173

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3740 COLONY DR.
Provider Second Line Business Practice Location Address:
SUITE 122
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78230-2234
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-846-1091
Provider Business Practice Location Address Fax Number:
210-541-0173
Provider Enumeration Date:
06/03/2013

Additional Information

Authorized Official

Authorized Official Last Name:
ALVAREZ
Authorized Official First Name:
JUANITA
Authorized Official Middle Name:
A
Authorized Official Title or Position:
LPC-S
Authorized Official Telephone Number:
210-846-1091

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  64833 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1356578827 . This is a "NPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 203338301 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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