Provider Demographics
NPI:1013200435
Name:ENHANCED LIVING COUNSELING
Entity Type:Organization
Organization Name:ENHANCED LIVING COUNSELING
Other - Org Name:IRASEMA GARCIA LPC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IRASEMA
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:817-992-0410
Mailing Address - Street 1:1196 VERDE OAKS LN
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76135-9034
Mailing Address - Country:US
Mailing Address - Phone:817-992-0410
Mailing Address - Fax:
Practice Address - Street 1:3301 HAMILTON AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-1898
Practice Address - Country:US
Practice Address - Phone:817-992-0410
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-18
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62036101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty