| Life Enrichment Services | |
|
1201 Pat Booker Rd Universal City TX 78148-3936 | |
| (210) 658-7337 | |
| (210) 658-7367 |
| Full Name | Life Enrichment Services |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 1201 Pat Booker Rd, Universal City, Texas |
| Authorized Official Name and Position | Kathleen M. White (OWNER) |
| Authorized Official Contact | 2106587337 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Life Enrichment Services Po Box 2517 Universal City TX 78148-1517 Ph: (210) 658-7337 | Life Enrichment Services 1201 Pat Booker Rd Universal City TX 78148-3936 Ph: (210) 658-7337 |
| NPI Number | 1780957019 |
|---|---|
| Provider Enumeration Date | 02/16/2012 |
| Last Update Date | 03/08/2012 |
| Medicare PECOS PAC ID | 0143481572 |
|---|---|
| Medicare Enrollment ID | O20120412000035 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780957019 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | SW00619 (Texas) | Primary |
| Provider Name | Kathleen M White |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1649355579 PECOS PAC ID: 5597926923 Enrollment ID: I20120412000057 |
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