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General NPI Number Information
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NPI Number | 1285924910
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Entity Type | Organization
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Legal Business Name | LIFE'S INTERSECTIONS LLC
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Dates
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Enumeration Date | 04/14/2011
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Last Update Date | 04/14/2011
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Provider Practice Location Address
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Address Line | 1202 LAKEWAY DR STE. 8
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City | LAKEWAY
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State | TX
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Zip | 78734-4473
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Country | US
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Telephone | 512-748-6373
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Fax | 512-551-0722
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Provider Business Mailing Address
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Address Line | 855 SUNFISH ST
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City | LAKEWAY
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State | TX
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Zip | 78734-4411
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Country | US
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Telephone | 512-748-6373
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Fax | 512-551-0722
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Authorized Official
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Title or Position | DIRECTOR/OWNER
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Name | DR. MARIA FISHEL
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Credential | PHD, LSSP
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Telephone | 512-748-6373
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 32643
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 34260
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License Number State | TX
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