Healthcare Provider Details

I. General information

NPI: 1093122483
Provider Name (Legal Business Name): LIFE TRANSFORMATION COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2014
Last Update Date: 01/21/2021
Certification Date: 01/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29149 CHAPEL PARK DR
WESLEY CHAPEL FL
33543-4423
US

IV. Provider business mailing address

29149 CHAPEL PARK DR
WESLEY CHAPEL FL
33543-4423
US

V. Phone/Fax

Practice location:
  • Phone: 813-280-2474
  • Fax: 813-341-5511
Mailing address:
  • Phone: 813-280-2474
  • Fax: 813-341-5511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberIMH 7823
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MRS. NATALIE SUE WEST SOUTHWARD
Title or Position: DIRECTOR AND HEAD COUNSELOR
Credential:
Phone: 813-280-2474