=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235175704
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHOOSING HOW I LIVE LIFE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/21/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1700 MONTOPOLIS DR
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78741-5138
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-385-4799
-----------------------------------------------------
Fax | 512-385-4838
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1700 MONTOPOLIS DR
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78741-5138
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-385-4799
-----------------------------------------------------
Fax | 512-385-4838
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PROGRAM DIRECTOR
-----------------------------------------------------
Name | MS. LORI D. WILSON
-----------------------------------------------------
Credential | LCDC
-----------------------------------------------------
Telephone | 512-385-4799
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | 1920-A
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------