Provider Demographics
NPI:1417228388
Name:LIFE 360 SOLUTIONS, LLC
Entity Type:Organization
Organization Name:LIFE 360 SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LELA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAMBERG
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:281-804-1900
Mailing Address - Street 1:11152 WESTHEIMER RD # 230
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77042-3208
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11200 BROADWAY ST STE 2743
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-9787
Practice Address - Country:US
Practice Address - Phone:281-804-1900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-24
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61023101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX192669301Medicaid