MEDICARE: LIFEWORKS FAMILY SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM1300X	Multi-Specialty Clinic/Center	3466	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235494261
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFEWORKS FAMILY SERVICES

Provider Business Mailing Address
First Line	:	1819 N FRONTAGE RD
Second Line	:	P.O. BOX 7
City	:	BEEVILLE
State	:	TX
Zip	:	78102-2937
Country	:	US
Telephone Number	:	361-362-9886
Fax Number	:	361-362-9820

Provider Business Practice Location Address
First Line	:	1819 N FRONTAGE RD
Second Line	:
City	:	BEEVILLE
State	:	TX
Zip	:	78102-2937
Country	:	US
Telephone Number	:	361-362-9886
Fax Number	:	361-362-9820

Authorized Official
Title or Position	:	OWNER
Name	:	MS. ALYCE YVONNE MARSTIN
Credential	:	LPC
Telephone Number	:	361-362-9886

Provider Enumeration Date	:	07/05/2012
Last Update Date	:	07/05/2012

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Directions to “LIFEWORKS FAMILY SERVICES ” Practice Location

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