Healthcare Provider Details

I. General information

NPI: 1346084779
Provider Name (Legal Business Name): LIFE ALIGN COUNSELING AND COACHING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2024
Last Update Date: 06/20/2024
Certification Date: 06/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 WATER ST STE 210
ASHLAND OR
97520-1841
US

IV. Provider business mailing address

303 W 1ST ST
PHOENIX OR
97535-7700
US

V. Phone/Fax

Practice location:
  • Phone: 541-326-7495
  • Fax: 458-658-5550
Mailing address:
  • Phone: 541-625-3138
  • Fax: 458-658-5550

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: MRS. SUNAURA SKYE BROWN
Title or Position: MENTAL HEALTH PROVIDER
Credential: LPC
Phone: 541-326-7495