Provider Demographics
NPI:1952495467
Name:NEW LIFE INSTITUTE
Entity Type:Organization
Organization Name:NEW LIFE INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:C
Authorized Official - Last Name:HAWKINS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:512-469-9447
Mailing Address - Street 1:PO BOX 4487
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78765-4487
Mailing Address - Country:US
Mailing Address - Phone:512-469-9447
Mailing Address - Fax:512-451-9694
Practice Address - Street 1:607 RATHERVUE PL
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-3127
Practice Address - Country:US
Practice Address - Phone:512-496-9447
Practice Address - Fax:512-451-9694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
TX21620103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0022MDOtherBC/BS GROUP #
TX00X336Medicare PIN