Provider Demographics
NPI:1558820928
Name:LIFE CYCLES COUNSELING
Entity Type:Organization
Organization Name:LIFE CYCLES COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARCEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GAMBOA
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:281-299-8607
Mailing Address - Street 1:5870 HIGHWAY 6 N STE 310
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-1850
Mailing Address - Country:US
Mailing Address - Phone:281-299-8607
Mailing Address - Fax:713-955-0275
Practice Address - Street 1:5870 HIGHWAY 6 N STE 310
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-1850
Practice Address - Country:US
Practice Address - Phone:281-299-8607
Practice Address - Fax:713-955-0275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-15
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX167999503Medicaid
TX1740306927OtherNPI TYPE 1