Provider Demographics
NPI:1588036370
Name:THE OAKS LIFE CENTER, PLLC
Entity Type:Organization
Organization Name:THE OAKS LIFE CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:B
Authorized Official - Last Name:COSGROVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:682-209-5662
Mailing Address - Street 1:6012 REEF POINT LN STE C
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76135-2056
Mailing Address - Country:US
Mailing Address - Phone:682-312-8184
Mailing Address - Fax:817-238-1232
Practice Address - Street 1:6012 REEF POINT LN
Practice Address - Street 2:SUITE C
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76135-7008
Practice Address - Country:US
Practice Address - Phone:682-312-8184
Practice Address - Fax:817-238-1232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-20
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 101YP2500X
TX334941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty