Healthcare Provider Details

I. General information

NPI: 1598981235
Provider Name (Legal Business Name): LIFE SKILLS THERAPY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2115 PLEASANTON RD SUITE 203
SAN ANTONIO TX
78221-1321
US

IV. Provider business mailing address

1016 FORT HOOD AVE APT 2
EDINBURG TX
78539-3332
US

V. Phone/Fax

Practice location:
  • Phone: 210-924-2115
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH DUAZO
Title or Position: PRESIDENT
Credential:
Phone: 956-383-1854