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General NPI Number Information
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NPI Number | 1518400837
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Entity Type | Organization
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Legal Business Name | LIFE COUNSELING AND CONSULTING, PLLC
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Dates
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Enumeration Date | 11/18/2016
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Last Update Date | 04/23/2017
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Provider Practice Location Address
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Address Line | 831 ROYAL GORGE BLVD SUITE 217
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City | CANON CITY
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State | CO
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Zip | 81212-6709
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Country | US
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Telephone | 719-722-2722
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Fax | 719-452-3752
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Provider Business Mailing Address
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Address Line | 831 ROYAL GORGE BLVD SUITE 217
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City | CANON CITY
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State | CO
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Zip | 81212-6709
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Country | US
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Telephone | 719-722-2722
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Fax | 719-452-3752
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Authorized Official
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Title or Position | MANAGER
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Name | LIFE COUNSELING AND CONSULTING PLLC
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Credential |
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Telephone | 605-941-6660
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | ACD40000646
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW09923604
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License Number State | CO
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