Healthcare Provider Details

I. General information

NPI: 1427324581
Provider Name (Legal Business Name): LIFE'S JOURNEY COUNSELING SERVICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2012
Last Update Date: 02/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 E A ST SUITE 201-B
CASPER WY
82601-2260
US

IV. Provider business mailing address

1300 E A ST SUITE 201-B
CASPER WY
82601-2260
US

V. Phone/Fax

Practice location:
  • Phone: 307-235-3333
  • Fax: 307-266-5155
Mailing address:
  • Phone: 307-235-3333
  • Fax: 307-266-5155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT117
License Number StateWY

VIII. Authorized Official

Name: DAMA W. MATCHETT
Title or Position: OWNER
Credential: LMFT
Phone: 307-235-3333