Healthcare Provider Details

I. General information

NPI: 1639648850
Provider Name (Legal Business Name): LYFE COUNSELING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2018
Last Update Date: 11/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4211 WHITNEY GREEN
SAN ANTONIO TX
78244-7824
US

IV. Provider business mailing address

4211 WHITNEY GREEN
SAN ANTONIO TX
78244
US

V. Phone/Fax

Practice location:
  • Phone: 210-781-5831
  • Fax:
Mailing address:
  • Phone: 210-781-5831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MISS LATRECIA FORD
Title or Position: CEO
Credential: LPC
Phone: 210-781-5831