MEDICARE: BEHAVIORAL LIFE ASSOCIATES

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	103TB0200X	Cognitive & Behavioral Psychologist	LPC 13830	TX

General Provider Information

NPI Number	:	1780693002
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEHAVIORAL LIFE ASSOCIATES

Provider Business Mailing Address
First Line	:	8852 CEDARSPUR DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77055-6665
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	952 ECHO LN
Second Line	:	STE # 335
City	:	HOUSTON
State	:	TX
Zip	:	77024-2757
Country	:	US
Telephone Number	:	713-984-2121
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. SAMUEL LEE
Credential	:	PH.D.
Telephone Number	:	713-984-2121

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	08/22/2020

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