=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144875147
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FAMILY LIFE CONCEPTS PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/06/2019
-----------------------------------------------------
Last Update Date | 08/06/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1939 W OWASSA RD
-----------------------------------------------------
City | EDINBURG
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78539-7048
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-704-9160
-----------------------------------------------------
Fax | 956-223-2552
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 3960
-----------------------------------------------------
City | MCALLEN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78502-3960
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-704-9160
-----------------------------------------------------
Fax | 956-223-2552
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. SOILA S GARCIA
-----------------------------------------------------
Credential | LCDC-I
-----------------------------------------------------
Telephone | 956-929-4651
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------