Life Fulfillment and Wellness LLC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

LIFE FULFILLMENT AND WELLNESS LLC

Practice address

4335 W Piedras Dr Ste 103
San Antonio, TX 78228-1215

Phone

(210) 600-4117

Fax

(210) 600-3849

NPI assigned

Jul 22, 2021

Last updated

Jul 22, 2021By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Imelda Ramirez Reveron, MHCNPI 1144893694

Title

Ceo/Administrator

Phone

(210) 600-4117

Specialties & licenses 2

Addresses

Other identifiers 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Imelda Ramirez Reveron, MA, CLINICIAN

  • Mental Health Counselor
  • San Antonio, TX
  • NPI 1144893694
  NPD Authorized official
• Edmundo Reveron-Questell, MD MPH

  • Family Medicine Physician
  • San Antonio, TX
  • NPI 1548206774
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1626912000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1626912000000",
    "number": "1619540077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21916 PARK VIEW DR",
            "city": "GARDEN RIDGE",
            "state": "TX",
            "postal_code": "782662749",
            "telephone_number": "210-844-9985",
            "fax_number": "210-600-3849"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4335 W PIEDRAS DR STE 103",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782281215",
            "telephone_number": "210-600-4117",
            "fax_number": "210-600-3849"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE FULFILLMENT AND WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-22",
        "last_updated": "2021-07-22",
        "certification_date": "2021-07-22",
        "status": "A",
        "authorized_official_last_name": "REVERON",
        "authorized_official_first_name": "IMELDA",
        "authorized_official_middle_name": "RAMIREZ",
        "authorized_official_title_or_position": "CEO/ADMINISTRATOR",
        "authorized_official_telephone_number": "210-600-4117",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MHC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1144893694",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Life Begins Anew Counseling and Consulting
• Life Changing Sleep LLC (LC Sleep)
• Life Choices Medical Clinic
• Life Choices Medical Clinic
• Life Designs
• Life in Praxis PLLC
• Life Savers of Texas
• Life Skills Therapy Center, LLC
• Life Smiles Unlimited, LP (Hill Country Dental)
• Lifecare of Texas Hospice LLC (LifeCare of Texas Hospice)

• Mental Health Counselor in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Mental Health Counselor in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.