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General NPI Number Information
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NPI Number | 1306164785
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Entity Type | Organization
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Legal Business Name | TRINITY LIFE COUNSELING
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Dates
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Enumeration Date | 05/11/2010
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Last Update Date | 06/18/2018
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Provider Practice Location Address
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Address Line | 16262 VIXEN RD
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City | STARK CITY
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State | MO
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Zip | 64866-7945
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Country | US
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Telephone | 417-388-9872
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Fax | 888-310-7328
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Provider Business Mailing Address
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Address Line | 16262 VIXEN RD
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City | STARK CITY
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State | MO
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Zip | 64866-7945
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Country | US
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Telephone | 417-388-9872
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Fax | 888-310-7328
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Authorized Official
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Title or Position | PRESIDENT
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Name | CYNTHIA LUNGSTRUM
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Credential | LCSW
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Telephone | 417-388-9872
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 2003018404
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License Number State | MO
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