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General NPI Number Information
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NPI Number | 1508176462
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Entity Type | Organization
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Legal Business Name | LIFEFORCE OPPORTUNITY INC
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Dates
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Enumeration Date | 10/13/2010
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Last Update Date | 10/13/2010
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Provider Practice Location Address
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Address Line | 5601 BRIDGE ST STE 300
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City | FORT WORTH
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State | TX
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Zip | 76112-2355
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Country | US
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Telephone | 817-492-7187
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Fax | 682-224-0965
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Provider Business Mailing Address
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Address Line | 5601 BRIDGE ST STE 300
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City | FORT WORTH
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State | TX
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Zip | 76112-2355
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Country | US
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Telephone | 817-492-7187
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Fax | 682-224-0965
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. CARY LINZY
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Credential |
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Telephone | 817-492-7187
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 5813
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 10641
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License Number State | TX
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