Provider Demographics
NPI:1912058637
Name:LIFE SKILLS THERAPY CENTER
Entity Type:Organization
Organization Name:LIFE SKILLS THERAPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:V
Authorized Official - Last Name:DUAZO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:956-383-1858
Mailing Address - Street 1:1016 FORT HOOD AVE
Mailing Address - Street 2:APT. 2
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-3331
Mailing Address - Country:US
Mailing Address - Phone:956-383-1858
Mailing Address - Fax:956-383-1857
Practice Address - Street 1:220 S BICENTENNIAL BLVD
Practice Address - Street 2:STE. A
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-7016
Practice Address - Country:US
Practice Address - Phone:956-688-6141
Practice Address - Fax:956-688-6997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0019MEOtherBCBS TX
TX137695OtherCHIPS
TX0019MEOtherBCBS TX