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General NPI Number Information
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NPI Number | 1558184325
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Entity Type | Organization
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Legal Business Name | PURE LIFE COUNSELING AND TESTING
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Dates
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Enumeration Date | 11/01/2024
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Last Update Date | 11/01/2024
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Provider Practice Location Address
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Address Line | 183 RIGBY ST
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City | MARION
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State | VA
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Zip | 24354-6342
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Country | US
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Telephone | 276-206-3040
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Fax | 540-527-9810
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Provider Business Mailing Address
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Address Line | PO BOX 1791
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City | MARION
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State | VA
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Zip | 24354-8689
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Country | US
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Telephone | 276-206-3040
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Fax | 540-527-9810
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Authorized Official
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Title or Position | OWNEER
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Name | MS. SHELBY COOK MITCHELL
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Credential | LPC
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Telephone | 276-206-3040
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD1600X
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Taxonomy Name | Developmental Disabilities 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 | 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 #3
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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