Healthcare Provider Details

I. General information

NPI: 1326511718
Provider Name (Legal Business Name): MORE LIFE COUNSELING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2019
Last Update Date: 06/14/2020
Certification Date: 06/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5060 N 19TH AVE STE 218
PHOENIX AZ
85015-3212
US

IV. Provider business mailing address

1300 S. WATSON RD. A 114 PMB 256
BUCKEYE AZ
85326-0112
US

V. Phone/Fax

Practice location:
  • Phone: 602-750-6043
  • Fax:
Mailing address:
  • Phone: 602-750-6043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. KATHRYN D DAVIS-LASHLEY
Title or Position: OWNER
Credential: LPC
Phone: 602-301-4647