Provider Demographics
NPI:1972067239
Name:LIFESEASONS NORTH TEXAS MEDICAL CLINIC PLLC
Entity Type:Organization
Organization Name:LIFESEASONS NORTH TEXAS MEDICAL CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RACHAEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-470-0726
Mailing Address - Street 1:4370 MEDICAL ARTS DR STE 315
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-1746
Mailing Address - Country:US
Mailing Address - Phone:469-470-0726
Mailing Address - Fax:
Practice Address - Street 1:4370 MEDICAL ARTS DR STE 315
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-1746
Practice Address - Country:US
Practice Address - Phone:469-470-0726
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-30
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty