Healthcare Provider Details

I. General information

NPI: 1437650785
Provider Name (Legal Business Name): LOUIS LIFE COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2018
Last Update Date: 03/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3567 W TURTLE RAPIDS LN
MERCER WI
54547-9800
US

IV. Provider business mailing address

3567 W TURTLE RAPIDS LN
MERCER WI
54547-9800
US

V. Phone/Fax

Practice location:
  • Phone: 920-450-6198
  • Fax:
Mailing address:
  • Phone: 920-450-6198
  • Fax:

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: ANNE LOUIS
Title or Position: OWNER
Credential: MS
Phone: 920-450-6198