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General NPI Number Information
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NPI Number | 1003392796
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Entity Type | Organization
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Legal Business Name | LIFE CENTERS, INC
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Dates
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Enumeration Date | 07/16/2018
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Last Update Date | 07/16/2018
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Provider Practice Location Address
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Address Line | 16000 W 9 MILE RD STE 200
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City | SOUTHFIELD
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State | MI
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Zip | 48075-4808
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Country | US
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Telephone | 248-579-2188
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Fax | 248-715-5903
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Provider Business Mailing Address
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Address Line | 25595 MULROY DR
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City | SOUTHFIELD
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State | MI
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Zip | 48033-2510
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Country | US
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Telephone | 602-791-1684
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | ROBIN ELAINE MCCOY
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Credential |
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Telephone | 248-579-2188
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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