Healthcare Provider Details

I. General information

NPI: 1528905445
Provider Name (Legal Business Name): LIFE POWER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

264 HOOKER LOOP
GILA NM
88038-9503
US

IV. Provider business mailing address

PO BOX 294
GILA NM
88038-0294
US

V. Phone/Fax

Practice location:
  • Phone: 575-313-2194
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MELISSA PALMER
Title or Position: OWNER
Credential: MA, LPCC
Phone: 575-313-2194