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General NPI Number Information
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NPI Number | 1295019131
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Entity Type | Organization
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Legal Business Name | LIFE SKILLS COUNSELING CENTER
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Dates
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Enumeration Date | 10/10/2011
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Last Update Date | 10/10/2011
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Provider Practice Location Address
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Address Line | 700 E SOUTHLAKE BLVD SUITE 190
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City | SOUTHLAKE
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State | TX
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Zip | 76092-6353
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Country | US
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Telephone | 817-416-2344
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Fax | 817-483-1198
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Provider Business Mailing Address
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Address Line | 5222 SARATOGA LN
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City | ARLINGTON
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State | TX
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Zip | 76017-1863
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Country | US
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Telephone | 214-535-6369
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Fax | 817-483-1198
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Authorized Official
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Title or Position | OWNER
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Name | DR. ADAM D COFFEY
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Credential | PH.D.
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Telephone | 214-535-6369
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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 | 13939
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License Number State | TX
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