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General NPI Number Information
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NPI Number | 1215415732
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Entity Type | Organization
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Legal Business Name | LIFES PATH THERAPY LLC
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Dates
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Enumeration Date | 08/06/2018
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Last Update Date | 08/06/2018
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Provider Practice Location Address
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Address Line | 922 CHURCH ST FL 2
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City | HONESDALE
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State | PA
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Zip | 18431-1921
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Country | US
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Telephone | 570-561-6626
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Fax | 570-904-8066
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Provider Business Mailing Address
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Address Line | 137 TRYON ST
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City | HONESDALE
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State | PA
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Zip | 18431-1126
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/ COUNSELOR
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Name | SARA WENTZ
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Credential | MA, NCC, LPC
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Telephone | 570-561-6626
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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 | PC010538
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License Number State | PA
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Taxonomy #2
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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 | PC010538
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License Number State | PA
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