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General NPI Number Information
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NPI Number | 1619574530
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Entity Type | Organization
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Legal Business Name | PURPOSED LIFE, LLC
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Dates
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Enumeration Date | 10/04/2020
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Last Update Date | 10/04/2020
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Provider Practice Location Address
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Address Line | 312 N DURHAM AVE
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City | GALLATIN
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State | TN
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Zip | 37066-2756
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Country | US
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Telephone | 615-241-9020
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Fax | 855-272-8329
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Provider Business Mailing Address
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Address Line | 312 N DURHAM AVE
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City | GALLATIN
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State | TN
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Zip | 37066-2756
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Country | US
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Telephone | 615-241-9020
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Fax | 855-272-8329
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Authorized Official
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Title or Position | MEMBER
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Name | BENJAMIN ROBERTS III
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Credential |
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Telephone | 615-241-9020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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