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General NPI Number Information
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NPI Number | 1720571326
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Entity Type | Organization
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Legal Business Name | SEXUAL LIFE IMPROVEMENT, PLLC
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Dates
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Enumeration Date | 06/08/2018
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 701 MORROW ST
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City | AUSTIN
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State | TX
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Zip | 78752-1337
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Country | US
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Telephone | 512-431-3721
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Fax |
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Provider Business Mailing Address
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Address Line | 701 MORROW ST
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City | AUSTIN
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State | TX
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Zip | 78752-1337
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Country | US
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Telephone | 512-431-3721
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. SHELLEY IMHOLTE
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Credential |
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Telephone | 512-431-3721
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 51195
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License Number State | TX
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