Provider Demographics
NPI:1578797809
Name:LIIFWERX
Entity Type:Organization
Organization Name:LIIFWERX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:DELANE
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-703-4082
Mailing Address - Street 1:13222 CHAMPIONS CENTRE DR
Mailing Address - Street 2:301
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77069-2339
Mailing Address - Country:US
Mailing Address - Phone:713-703-4082
Mailing Address - Fax:
Practice Address - Street 1:13222 CHAMPIONS CENTRE DR
Practice Address - Street 2:301
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77069-2339
Practice Address - Country:US
Practice Address - Phone:713-703-4082
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-15
Last Update Date:2009-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty