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Organization
LIFE FULFILLMENT AND WELLNESS LLC
Active
Organization
LIFE FULFILLMENT AND WELLNESS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. IMELDA RAMIREZ REVERON MHC (CEO/ADMINISTRATOR)
(210) 600-4117
Entity
Organization
Contact information
Practice address
4335 W PIEDRAS DR STE 103, SAN ANTONIO, TX 78228-1215
(210) 600-4117
(210) 600-3849
Mailing address
21916 PARK VIEW DR, GARDEN RIDGE, TX 78266-2749
(210) 844-9985
(210) 600-3849
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
207Q00000X
Family Medicine Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1144893694
—
TX
Enumeration date
07/22/2021
Last updated
07/22/2021
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