Provider Demographics
NPI:1992137350
Name:LIVINGWELL FAMILY PSYCHIATRIC SERVICES
Entity type:Organization
Organization Name:LIVINGWELL FAMILY PSYCHIATRIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:S
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:210-884-4682
Mailing Address - Street 1:3903 WISEMAN BLVD
Mailing Address - Street 2:STE 211
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-4401
Mailing Address - Country:US
Mailing Address - Phone:210-877-0700
Mailing Address - Fax:210-877-0704
Practice Address - Street 1:3903 WISEMAN BLVD
Practice Address - Street 2:STE 211
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-4401
Practice Address - Country:US
Practice Address - Phone:210-877-0700
Practice Address - Fax:210-877-0704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-07
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX614025363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty