MEDICARE: LIFEBRANCH BEHAVIORAL HEALTH CARE SYSTEMS,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
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1891907333
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFEBRANCH BEHAVIORAL HEALTH CARE SYSTEMS,INC.

Provider Business Mailing Address
First Line	:	2626 SOUTH LOOP WEST
Second Line	:	SUITE 118
City	:	HOUSTON
State	:	TX
Zip	:	77054-2679
Country	:	US
Telephone Number	:	713-665-0837
Fax Number	:	713-665-0894

Provider Business Practice Location Address
First Line	:	2626 SOUTH LOOP WEST
Second Line	:	SUITE 118
City	:	HOUSTON
State	:	TX
Zip	:	77054
Country	:	US
Telephone Number	:	713-665-0837
Fax Number	:	713-665-0894

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. JULIA M SHAW
Credential	:
Telephone Number	:	713-665-0837

Provider Enumeration Date	:	05/04/2007
Last Update Date	:	09/28/2009

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