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General NPI Number Information
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NPI Number | 1366808115
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Entity Type | Organization
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Legal Business Name | LIFEWAY INTERNATIONAL HOUSTON LLC
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Dates
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Enumeration Date | 01/09/2016
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Last Update Date | 08/02/2016
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Provider Practice Location Address
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Address Line | 10110 W SAM HOUSTON PKWY S SUITE 110
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City | HOUSTON
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State | TX
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Zip | 77099-5152
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Country | US
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Telephone | 713-270-6753
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Fax |
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Provider Business Mailing Address
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Address Line | 5090 RICHMOND AVE #458
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City | HOUSTON
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State | TX
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Zip | 77056-7402
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Country | US
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Telephone | 713-270-6753
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MICHAEL ROSS
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Credential |
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Telephone | 713-270-6753
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 76022
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License Number State | TX
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Taxonomy #2
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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 | TX
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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 58876
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 59535
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License Number State | TX
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Taxonomy #5
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 59011
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License Number State | TX
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Taxonomy #6
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 57841
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License Number State | TX
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Taxonomy #7
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 70670
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License Number State | TX
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Taxonomy #8
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 51644
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License Number State | TX
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