Provider Demographics
NPI:1386154086
Name:FAMILY LIFE COUNSELING, LLC
Entity type:Organization
Organization Name:FAMILY LIFE COUNSELING, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LCSW AND OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:AVINA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:210-544-3719
Mailing Address - Street 1:225 MARY LOUISE DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78201-4422
Mailing Address - Country:US
Mailing Address - Phone:210-544-3719
Mailing Address - Fax:
Practice Address - Street 1:4606 CENTERVIEW STE 185
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78228-1230
Practice Address - Country:US
Practice Address - Phone:210-675-0066
Practice Address - Fax:210-618-0324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-07
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18902101YM0800X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX101858206Medicaid