Healthcare Provider Details

I. General information

NPI: 1275189490
Provider Name (Legal Business Name): LIFE'S WORK CLINIC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2019
Last Update Date: 06/08/2023
Certification Date: 06/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 W 3RD ST UNIT E
KALKASKA MI
49646-5107
US

IV. Provider business mailing address

103 W 3RD ST. UNIT E - 524
KALKASKA MI
49646-0524
US

V. Phone/Fax

Practice location:
  • Phone: 231-620-7977
  • Fax: 231-715-3222
Mailing address:
  • Phone: 231-620-7977
  • Fax: 231-715-3222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ADAM DEVANEY
Title or Position: OWNER
Credential: CLINICAL SOCIAL WORK
Phone: 231-620-7977