MEDICARE: LIFE 2.0 BEHAVIORAL HEALTH SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101Y00000X	Counselor
2	171M00000X	Case Manager/Care Coordinator
3	261QM0850X	Adult Mental Health Clinic/Center
4	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1770215998
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFE 2.0 BEHAVIORAL HEALTH SERVICES

Provider Business Mailing Address
First Line	:	1801 N HAMPTON RD STE 300
Second Line	:
City	:	DESOTO
State	:	TX
Zip	:	75115-2399
Country	:	US
Telephone Number	:	469-222-1200
Fax Number	:	214-432-1700

Provider Business Practice Location Address
First Line	:	1801 N HAMPTON RD STE 300
Second Line	:
City	:	DESOTO
State	:	TX
Zip	:	75115-2399
Country	:	US
Telephone Number	:	469-222-1200
Fax Number	:	214-432-1700

Authorized Official
Title or Position	:	CEO
Name	:	MS. CINDY JOHNSON
Credential	:
Telephone Number	:	469-222-1200

Provider Enumeration Date	:	06/27/2022
Last Update Date	:	06/27/2022

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