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General NPI Number Information
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NPI Number | 1194175497
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Entity Type | Organization
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Legal Business Name | LIFE SUPPORT THERAPY SERVICES LLC
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Dates
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Enumeration Date | 06/16/2016
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Last Update Date | 09/10/2024
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Provider Practice Location Address
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Address Line | 4035 NORTHPOINTE DR UNIT B
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City | ZANESVILLE
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State | OH
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Zip | 43701-1738
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Country | US
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Telephone | 740-487-1768
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Fax | 740-870-0086
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Provider Business Mailing Address
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Address Line | PO BOX 2828
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City | ZANESVILLE
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State | OH
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Zip | 43702-2828
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Country | US
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Telephone | 740-487-1768
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Fax | 740-870-0086
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | JACQUIE KIRKBRIDE
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Credential | MSW, LSW
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Telephone | 740-487-1768
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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