Healthcare Provider Details

I. General information

NPI: 1073054359
Provider Name (Legal Business Name): LIFE LAUNCH COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2017
Last Update Date: 03/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3030 S 9TH ST STE 3F
KALAMAZOO MI
49009-9456
US

IV. Provider business mailing address

3030 S 9TH ST STE 3F
KALAMAZOO MI
49009-9456
US

V. Phone/Fax

Practice location:
  • Phone: 269-743-6139
  • Fax:
Mailing address:
  • Phone: 269-743-6139
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401008766
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6301011550
License Number StateMI

VIII. Authorized Official

Name: MARYANN RIGONI-SOUTHLAND
Title or Position: DIRECTOR
Credential: MA
Phone: 269-743-6139