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General NPI Number Information
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NPI Number | 1538012018
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Entity Type | Organization
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Legal Business Name | LIFECRAFTERS LLC
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Dates
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Enumeration Date | 02/16/2026
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Last Update Date | 02/16/2026
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Provider Practice Location Address
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Address Line | 600 HIGH ST
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City | HAZARD
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State | KY
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Zip | 41701-1310
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Country | US
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Telephone | 859-630-7760
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Fax |
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Provider Business Mailing Address
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Address Line | 369 W VINE ST APT 1906
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City | LEXINGTON
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State | KY
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Zip | 40507-1697
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Country | US
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Telephone | 859-630-7760
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Fax |
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | MADISON WALLACE
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Credential | LPCC
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Telephone | 859-630-7760
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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