Provider Demographics
NPI:1184666828
Name:LIVING FULL CIRCLE, INC.
Entity Type:Organization
Organization Name:LIVING FULL CIRCLE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:JEANNA
Authorized Official - Middle Name:P
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LISW, LCSW, LADAC
Authorized Official - Phone:713-660-0776
Mailing Address - Street 1:6300 W LOOP SOUTH
Mailing Address - Street 2:SUITE 575
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77401-2900
Mailing Address - Country:US
Mailing Address - Phone:713-660-0776
Mailing Address - Fax:
Practice Address - Street 1:6300 W LOOP SOUTH
Practice Address - Street 2:SUITE 575
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77401-2900
Practice Address - Country:US
Practice Address - Phone:713-660-0776
Practice Address - Fax:713-660-0033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX182207401Medicaid
NM06332803Medicaid
TX00W633Medicare PIN
NM300521080Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER
NM343521500Medicare PIN