Healthcare Provider Details

I. General information

NPI: 1114292042
Provider Name (Legal Business Name): LIFES HEALTHY PATHWAYS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2012
Last Update Date: 03/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 S BRIDGE ST SUITE 220
DEWITT MI
48820-8825
US

IV. Provider business mailing address

134 W MAPLE ST PO BOX 10
MASON MI
48854-1657
US

V. Phone/Fax

Practice location:
  • Phone: 517-277-0200
  • Fax:
Mailing address:
  • Phone: 517-676-9788
  • Fax: 517-676-3438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801083840
License Number StateMI

VIII. Authorized Official

Name: MARILYN RUTH-COOMBS MCLANE
Title or Position: OWNER
Credential: LMSW
Phone: 517-277-0200