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General NPI Number Information
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NPI Number | 1235493065
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Entity Type | Organization
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Legal Business Name | LIFEWORKS WELLNESS CENTER
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Dates
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Enumeration Date | 06/26/2012
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Last Update Date | 06/26/2012
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Provider Practice Location Address
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Address Line | 100 E JEFFERSON ST SUITE 4
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City | GILMER
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State | TX
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Zip | 75644-2200
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Country | US
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Telephone | 903-841-4308
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Fax | 903-841-4308
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Provider Business Mailing Address
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Address Line | PO BOX 331
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City | GILMER
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State | TX
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Zip | 75644-0331
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Country | US
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Telephone | 903-841-4308
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Fax | 903-841-4308
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Authorized Official
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Title or Position | OWNER
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Name | MR. DARRELL RICHARD SMITH
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Credential | M.ED., LPC
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Telephone | 903-841-4308
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 61069
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License Number State | TX
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