Healthcare Provider Details

I. General information

NPI: 1669068284
Provider Name (Legal Business Name): FULL LIFE PSYCHOLOGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2020
Last Update Date: 12/19/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2629 E YANDELL DR STE A
EL PASO TX
79903-3724
US

IV. Provider business mailing address

2629 E YANDELL DR STE A
EL PASO TX
79903-3724
US

V. Phone/Fax

Practice location:
  • Phone: 915-233-7145
  • Fax: 915-200-0698
Mailing address:
  • Phone: 915-233-7145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: ANA LAURA JAMES
Title or Position: MANAGER
Credential: PHD
Phone: 915-929-7718