Provider Demographics
NPI:1346689320
Name:LIFE'S JOURNEY COUNSELING AND COMMUNITY SERVICES
Entity Type:Organization
Organization Name:LIFE'S JOURNEY COUNSELING AND COMMUNITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LATOYA
Authorized Official - Middle Name:CHANELL
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MA,LPC,NCC
Authorized Official - Phone:281-746-2704
Mailing Address - Street 1:19123 DAWNTREADER DR
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-4323
Mailing Address - Country:US
Mailing Address - Phone:281-746-2704
Mailing Address - Fax:832-413-5072
Practice Address - Street 1:17510 HUFFMEISTER RD
Practice Address - Street 2:105
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429
Practice Address - Country:US
Practice Address - Phone:281-746-2704
Practice Address - Fax:832-413-5072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-23
Last Update Date:2013-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX287170902Medicaid