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General NPI Number Information
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NPI Number | 1932755261
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Entity Type | Organization
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Legal Business Name | LIFEWORKS BEHAVIORAL HEALTH & CONSULTING PLLC
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Dates
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Enumeration Date | 08/13/2019
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Last Update Date | 09/03/2019
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Provider Practice Location Address
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Address Line | 2820 W AVENUE O STE B
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City | TEMPLE
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State | TX
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Zip | 76504-6417
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Country | US
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Telephone | 254-213-1501
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 10284
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City | KILLEEN
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State | TX
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Zip | 76547-0284
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Country | US
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Telephone | 254-213-1501
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | MRS. TANEKA PATRICK
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Credential | LCSW
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Telephone | 254-213-1501
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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