Provider Demographics
NPI:1679791677
Name:LIFE SUPPORT COUNSELING AND RESEARCH
Entity type:Organization
Organization Name:LIFE SUPPORT COUNSELING AND RESEARCH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LEON
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LSOTP
Authorized Official - Phone:512-451-7310
Mailing Address - Street 1:3809 S 2ND ST STE C400
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-7059
Mailing Address - Country:US
Mailing Address - Phone:512-451-7310
Mailing Address - Fax:512-451-0394
Practice Address - Street 1:3809 S 2ND ST STE C400
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-7059
Practice Address - Country:US
Practice Address - Phone:512-451-7310
Practice Address - Fax:512-451-0394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No251B00000XAgenciesCase ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX153602101Medicaid
TX109348601Medicaid
TX109348602Medicaid
TX080030201Medicaid