Healthcare Provider Details

I. General information

NPI: 1104564145
Provider Name (Legal Business Name): LIFE MATTERS PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2022
Last Update Date: 11/04/2022
Certification Date: 09/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4025 W BROADWAY AVE
MINNEAPOLIS MN
55422-2211
US

IV. Provider business mailing address

11657 PONDVIEW CT
CHAMPLIN MN
55316-2629
US

V. Phone/Fax

Practice location:
  • Phone: 763-898-3323
  • Fax:
Mailing address:
  • Phone: 952-992-0023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: DAVID LOHSE
Title or Position: COO
Credential:
Phone: 763-898-3323