Provider Demographics
NPI:1821756768
Name:LIVING TREE CASE MANAGEMENT AND SKILLS TRAINING CENTER LLC
Entity Type:Organization
Organization Name:LIVING TREE CASE MANAGEMENT AND SKILLS TRAINING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:NEDOCK
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:252-764-1154
Mailing Address - Street 1:1067 FM 306 STE 402
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-6895
Mailing Address - Country:US
Mailing Address - Phone:281-925-7780
Mailing Address - Fax:210-783-1646
Practice Address - Street 1:1067 FM 306 STE 402
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-6895
Practice Address - Country:US
Practice Address - Phone:281-925-7780
Practice Address - Fax:210-783-1646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-07
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health