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General NPI Number Information
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NPI Number | 1023602471
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Entity Type | Organization
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Legal Business Name | LIVE LIFE WELLNESS CLINIC LLC
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Dates
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Enumeration Date | 02/25/2021
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 5718 WESTHEIMER RD STE 1000
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City | HOUSTON
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State | TX
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Zip | 77057
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Country | US
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Telephone | 678-799-5331
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Fax |
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Provider Business Mailing Address
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Address Line | 5718 WESTHEIMER RD STE 1000
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City | HOUSTON
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State | TX
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Zip | 77057-9903
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Country | US
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Telephone | 678-799-5331
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LIDIA LIFE WELLNESS CLINIC MCKINNEY
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Credential |
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Telephone | 832-672-4893
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 261QR0800X
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Taxonomy Name | Recovery Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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Taxonomy #10
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #11
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #12
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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