Provider Demographics
NPI:1417796905
Name:LIFE MENTAL HEALTH SERVICES OF TEXAS, LLC
Entity type:Organization
Organization Name:LIFE MENTAL HEALTH SERVICES OF TEXAS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRITTANY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROCHE
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:678-937-3267
Mailing Address - Street 1:2626 S LOOP W STE 650
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-2654
Mailing Address - Country:US
Mailing Address - Phone:678-937-3267
Mailing Address - Fax:
Practice Address - Street 1:2626 S LOOP W STE 650
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-2654
Practice Address - Country:US
Practice Address - Phone:678-937-3267
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-23
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty