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General NPI Number Information
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NPI Number | 1366883274
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Entity Type | Organization
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Legal Business Name | LIFE PATHS COUNSELING, LLC
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Dates
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Enumeration Date | 07/09/2013
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Last Update Date | 12/22/2014
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Provider Practice Location Address
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Address Line | 101 W KIRKWOOD AVE STE 222
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City | BLOOMINGTON
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State | IN
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Zip | 47404-6133
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Country | US
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Telephone | 812-361-1234
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Fax |
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Provider Business Mailing Address
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Address Line | 101 W KIRKWOOD AVE STE 222
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City | BLOOMINGTON
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State | IN
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Zip | 47404-6133
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Country | US
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Telephone | 812-361-1234
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Fax | 812-676-9351
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Authorized Official
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Title or Position | OWNER
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Name | HEATHER M HUDSON
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Credential | LCSW
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Telephone | 812-361-1234
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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 | 34005660A
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License Number State | IN
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