| Organization Name: | LIFE GATE CHURCH INC |
| NPI Number: | 1013289149 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CHARLES C BORSELLINO (MANAGER) |
| Mailing Address: | 102 Bayne Rd Haslet |
| State: | TX US |
| Postal Code: | 760524614 |
| Phone Number: | 8176758135 |
| Fax Number: | |
| NPI Enumeration Date: | 02/06/2012 |
| NPI Last Update Date: | 04/04/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |