Provider Demographics
NPI:1376731554
Name:WTL-THE WAY, TRUTH, AND LIFE OUTREACH
Entity Type:Organization
Organization Name:WTL-THE WAY, TRUTH, AND LIFE OUTREACH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:LEMELLE
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSN, FNP
Authorized Official - Phone:936-372-9007
Mailing Address - Street 1:30443 BETKA RD
Mailing Address - Street 2:
Mailing Address - City:WALLER
Mailing Address - State:TX
Mailing Address - Zip Code:77484-4952
Mailing Address - Country:US
Mailing Address - Phone:936-372-9007
Mailing Address - Fax:936-372-3003
Practice Address - Street 1:30443 BETKA RD
Practice Address - Street 2:
Practice Address - City:WALLER
Practice Address - State:TX
Practice Address - Zip Code:77484-4952
Practice Address - Country:US
Practice Address - Phone:936-372-9007
Practice Address - Fax:936-372-3003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-12
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management