Provider Demographics
NPI:1639648850
Name:LYFE COUNSELING PLLC
Entity Type:Organization
Organization Name:LYFE COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:LATRECIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:210-781-5831
Mailing Address - Street 1:4211 WHITNEY GREEN
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78244
Mailing Address - Country:US
Mailing Address - Phone:210-781-5831
Mailing Address - Fax:
Practice Address - Street 1:4211 WHITNEY GREEN
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78244-7824
Practice Address - Country:US
Practice Address - Phone:210-781-5831
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-16
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty