Provider Demographics
NPI:1619572500
Name:EXPAND LIFE COUNSELING PLLC
Entity Type:Organization
Organization Name:EXPAND LIFE COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST AND OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASANDRA
Authorized Official - Middle Name:LOURDES
Authorized Official - Last Name:OEFFINGER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-SUPERVISOR
Authorized Official - Phone:713-268-0979
Mailing Address - Street 1:6102 AUTUMN FOREST DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77092-2312
Mailing Address - Country:US
Mailing Address - Phone:713-254-6873
Mailing Address - Fax:
Practice Address - Street 1:627 W 19TH ST STE 201
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-3658
Practice Address - Country:US
Practice Address - Phone:713-268-0979
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-01
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)