Healthcare Provider Details

I. General information

NPI: 1245991264
Provider Name (Legal Business Name): LIFE COMPASS INTEGRATIVE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2022
Last Update Date: 01/02/2022
Certification Date: 01/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 E ST STE 2E
DAVIS CA
95616-4572
US

IV. Provider business mailing address

105 E ST STE 2E
DAVIS CA
95616-4572
US

V. Phone/Fax

Practice location:
  • Phone: 530-601-1003
  • Fax:
Mailing address:
  • Phone: 530-601-1003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MS. CARMEN ISAIS
Title or Position: DIRECTOR
Credential: LMFT
Phone: 530-601-1003