Provider Demographics
NPI:1235175704
Name:CHOOSING HOW I LIVE LIFE, INC.
Entity Type:Organization
Organization Name:CHOOSING HOW I LIVE LIFE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:D
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCDC
Authorized Official - Phone:512-385-4799
Mailing Address - Street 1:1700 MONTOPOLIS DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78741-5138
Mailing Address - Country:US
Mailing Address - Phone:512-385-4799
Mailing Address - Fax:512-385-4838
Practice Address - Street 1:1700 MONTOPOLIS DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78741-5138
Practice Address - Country:US
Practice Address - Phone:512-385-4799
Practice Address - Fax:512-385-4838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1920-A101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0654832Medicaid