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General NPI Number Information
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NPI Number | 1013625334
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Entity Type | Organization
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Legal Business Name | LIFE COUNSELING LLC
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Dates
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Enumeration Date | 11/07/2022
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Last Update Date | 11/07/2022
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Provider Practice Location Address
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Address Line | 2135 S EASTGATE AVE
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City | SPRINGFIELD
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State | MO
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Zip | 65809-2146
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Country | US
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Telephone | 417-221-6252
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Fax |
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Provider Business Mailing Address
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Address Line | 2401 W RICHWOOD RD
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City | OZARK
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State | MO
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Zip | 65721-6018
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Country | US
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Telephone | 417-343-9939
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Fax |
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Authorized Official
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Title or Position | LICENSED PROFESSIONAL COUNSELOR
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Name | SHAUN LOTTER
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Credential | LPC
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Telephone | 417-343-9939
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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