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NPI Code Detail

MEDICARE: LIFEFORCE OPPORTUNITY INC

MEDICARE: LIFEFORCE OPPORTUNITY INC
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
1101YA0400XAddiction (Substance Use Disorder) Counselor5813TX
2101YA0400XAddiction (Substance Use Disorder) Counselor10641TX

General Provider Information

NPI Number : 1508176462
Entity Type Code : Organization
Provider Name (Legal Business Name) : LIFEFORCE OPPORTUNITY INC
Provider Business Mailing Address
First Line : 5601 BRIDGE ST STE 300
Second Line :
City : FORT WORTH
State : TX
Zip : 76112-2355
Country : US
Telephone Number : 817-492-7187
Fax Number : 682-224-0965
Provider Business Practice Location Address
First Line : 5601 BRIDGE ST STE 300
Second Line :
City : FORT WORTH
State : TX
Zip : 76112-2355
Country : US
Telephone Number : 817-492-7187
Fax Number : 682-224-0965
Authorized Official
Title or Position : DIRECTOR
Name : MS. CARY LINZY
Credential :
Telephone Number : 817-492-7187
Provider Enumeration Date : 10/13/2010
Last Update Date : 10/13/2010

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Directions to “LIFEFORCE OPPORTUNITY INC ” Practice Location

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