Provider Demographics
NPI:1235494261
Name:LIFEWORKS FAMILY SERVICES
Entity type:Organization
Organization Name:LIFEWORKS FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ALYCE
Authorized Official - Middle Name:YVONNE
Authorized Official - Last Name:MARSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:361-362-9886
Mailing Address - Street 1:1819 N FRONTAGE RD
Mailing Address - Street 2:P.O. BOX 7
Mailing Address - City:BEEVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78102-2937
Mailing Address - Country:US
Mailing Address - Phone:361-362-9886
Mailing Address - Fax:361-362-9820
Practice Address - Street 1:1819 N FRONTAGE RD
Practice Address - Street 2:
Practice Address - City:BEEVILLE
Practice Address - State:TX
Practice Address - Zip Code:78102-2937
Practice Address - Country:US
Practice Address - Phone:361-362-9886
Practice Address - Fax:361-362-9820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-05
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3466261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX169619701Medicaid
TX169619701Medicaid