Healthcare Provider Details

I. General information

NPI: 1407097371
Provider Name (Legal Business Name): LIFE POINT COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2009
Last Update Date: 04/27/2023
Certification Date: 04/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2209 EASTERN AVE
PLYMOUTH WI
53073-4281
US

IV. Provider business mailing address

2209 EASTERN AVE
PLYMOUTH WI
53073-4281
US

V. Phone/Fax

Practice location:
  • Phone: 920-892-7606
  • Fax: 920-449-4247
Mailing address:
  • Phone: 920-892-7606
  • Fax: 920-449-4247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number3459-125
License Number StateWI

VIII. Authorized Official

Name: MOLLY ELLEN STEUERWALD
Title or Position: OFFICE MANAGER
Credential:
Phone: 920-892-7606