Provider Demographics
NPI:1235493065
Name:LIFEWORKS WELLNESS CENTER
Entity type:Organization
Organization Name:LIFEWORKS WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DARRELL
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MED, LPC
Authorized Official - Phone:903-841-4308
Mailing Address - Street 1:PO BOX 331
Mailing Address - Street 2:
Mailing Address - City:GILMER
Mailing Address - State:TX
Mailing Address - Zip Code:75644-0331
Mailing Address - Country:US
Mailing Address - Phone:903-841-4308
Mailing Address - Fax:903-841-4308
Practice Address - Street 1:100 E JEFFERSON ST
Practice Address - Street 2:SUITE 4
Practice Address - City:GILMER
Practice Address - State:TX
Practice Address - Zip Code:75644-2200
Practice Address - Country:US
Practice Address - Phone:903-841-4308
Practice Address - Fax:903-841-4308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-26
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61069101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty