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General NPI Number Information
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NPI Number | 1275437329
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Entity Type | Organization
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Legal Business Name | LIFE PHASES LLC
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Dates
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Enumeration Date | 10/05/2026
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Last Update Date | 10/05/2026
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Provider Practice Location Address
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Address Line | 4861 IMPERIAL DR
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City | LIBERTY TWP
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State | OH
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Zip | 45011-9089
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Country | US
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Telephone | 513-405-7862
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Fax |
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Provider Business Mailing Address
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Address Line | 4861 IMPERIAL DR
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City | LIBERTY TWP
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State | OH
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Zip | 45011-9089
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Country | US
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Telephone | 513-405-7862
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Fax |
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Authorized Official
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Title or Position | CLINICAL COUNSELOR
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Name | TANISHA PERINE-DIXON
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Credential | LPCC-S
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Telephone | 513-405-7862
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | NULL
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