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General NPI Number Information
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NPI Number | 1598169518
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Entity Type | Organization
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Legal Business Name | LIFEGATE CHRISTIAN COUNSELING
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Dates
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Enumeration Date | 10/20/2014
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Last Update Date | 10/20/2014
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Provider Practice Location Address
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Address Line | 6820 W 26TH ST
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City | SIOUX FALLS
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State | SD
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Zip | 57106-4554
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Country | US
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Telephone | 605-929-1060
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Fax | 605-370-5330
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Provider Business Mailing Address
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Address Line | 2229 S PURDUE AVE
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City | SIOUX FALLS
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State | SD
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Zip | 57106-5141
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Country | US
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Telephone | 605-929-1060
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Fax | 605-370-5330
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Authorized Official
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Title or Position | OWNER
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Name | DR. LARRY PORTER
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Credential | PHD
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Telephone | 605-929-1060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LMFT1176
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License Number State | SD
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