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General NPI Number Information
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NPI Number | 1184089401
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Entity Type | Organization
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Legal Business Name | LIFE REFORMATION COUNSELING
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Dates
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Enumeration Date | 12/31/2015
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Last Update Date | 12/31/2015
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Provider Practice Location Address
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Address Line | 1009 SE EDWARDS DR
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City | DUNDEE
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State | OR
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Zip | 97115-9601
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Country | US
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Telephone | 971-732-6614
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Fax |
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Provider Business Mailing Address
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Address Line | 1009 SE EDWARDS DR
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City | DUNDEE
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State | OR
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Zip | 97115-9601
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Country | US
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Telephone | 971-732-6614
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Fax |
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Authorized Official
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Title or Position | COUNSELOR
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Name | LUKE C MATTEUCCI
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Credential | MS MA LPC NCC MAC
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Telephone | 971-732-6614
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | C3379
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License Number State | OR
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