| Life Fulfillment And Wellness Llc | |
|
4335 W Piedras Dr Ste 103 San Antonio TX 78228-1215 | |
| (210) 600-4117 | |
| (210) 600-3849 |
| Full Name | Life Fulfillment And Wellness Llc |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 4335 W Piedras Dr Ste 103, San Antonio, Texas |
| Authorized Official Name and Position | Imelda Ramirez Reveron (CEO/ADMINISTRATOR) |
| Authorized Official Contact | 2106004117 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Life Fulfillment And Wellness Llc 21916 Park View Dr Garden Ridge TX 78266-2749 Ph: (210) 844-9985 | Life Fulfillment And Wellness Llc 4335 W Piedras Dr Ste 103 San Antonio TX 78228-1215 Ph: (210) 600-4117 |
| NPI Number | 1619540077 |
|---|---|
| Provider Enumeration Date | 07/22/2021 |
| Last Update Date | 07/22/2021 |
| Certification Date | 07/22/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619540077 | NPI | - | NPPES |
| 1144893694 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
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