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NPI Code Detail

MEDICARE: KINGDOM LIFE COUNSELING LLC

MEDICARE: KINGDOM LIFE COUNSELING LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251S00000XCommunity/Behavioral Health Agency2002026260MO

General Provider Information

NPI Number : 1144648569
Entity Type Code : Organization
Provider Name (Legal Business Name) : KINGDOM LIFE COUNSELING LLC
Provider Business Mailing Address
First Line : 112 S MADISON AVE
Second Line :
City : AURORA
State : MO
Zip : 65605-1427
Country : US
Telephone Number : 417-229-2548
Fax Number :
Provider Business Practice Location Address
First Line : 112 S MADISON AVE
Second Line :
City : AURORA
State : MO
Zip : 65605-1427
Country : US
Telephone Number : 417-229-2548
Fax Number :
Authorized Official
Title or Position : DIRECTOR
Name : KEN KUSCHEL
Credential : LPC
Telephone Number : 417-229-2548
Provider Enumeration Date : 04/02/2014
Last Update Date : 04/02/2014

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Directions to “KINGDOM LIFE COUNSELING LLC ” Practice Location

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