Provider Demographics
NPI:1235616566
Name:LIFESTEPS COUNCIL FOR ALCOHOL & DRUGS
Entity Type:Organization
Organization Name:LIFESTEPS COUNCIL FOR ALCOHOL & DRUGS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR, PPI/PADRE
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:LCDC, LMSW
Authorized Official - Phone:512-869-2571
Mailing Address - Street 1:PO BOX 1279
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78627-1279
Mailing Address - Country:US
Mailing Address - Phone:512-869-2571
Mailing Address - Fax:512-246-9880
Practice Address - Street 1:311 S MAIN ST
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626-5048
Practice Address - Country:US
Practice Address - Phone:512-869-2571
Practice Address - Fax:512-869-1667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-19
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2766232152OtherCMBHS