Healthcare Provider Details

I. General information

NPI: 1427371426
Provider Name (Legal Business Name): LIFE IMPROVEMENT COUNSELING CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2010
Last Update Date: 03/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

418 WATT STREET
JEFFERSONVILLE IN
47130
US

IV. Provider business mailing address

418 WATT STREET
JEFFERSONVILLE IN
47130
US

V. Phone/Fax

Practice location:
  • Phone: 812-288-8030
  • Fax: 812-288-8032
Mailing address:
  • Phone: 812-288-8030
  • Fax: 812-288-8032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: MISS PATRICIA ROSE
Title or Position: CONTRACTING SPECIALIST
Credential:
Phone: 502-489-7122