Organization
CHOOSING HOW I LIVE LIFE OUTPATIENT SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LORI D. WILSON LCDC (PROGRAM DIRECTOER)
(512) 385-4799
Entity
Organization
Contact information
Practice address
1700 MONTOPOLIS DR STE D, AUSTIN, TX 78741-5138
(512) 385-4799
Mailing address
1700 MONTOPOLIS DR STE D, AUSTIN, TX 78741-5138
(512) 385-4799
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
1920-1920 A
TX
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
065483201
—
TX
Enumeration date
12/12/2008
Last updated
01/05/2010
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