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General NPI Number Information
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NPI Number | 1649096819
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Entity Type | Organization
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Legal Business Name | LIFE'S PHASES, LLC
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Dates
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Enumeration Date | 12/03/2024
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Last Update Date | 12/09/2024
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Provider Practice Location Address
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Address Line | 4660 MARSH RD
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City | OKEMOS
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State | MI
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Zip | 48864-2143
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Country | US
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Telephone | 616-541-4507
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Fax |
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Provider Business Mailing Address
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Address Line | 1917 MARION AVE
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City | LANSING
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State | MI
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Zip | 48910-9043
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Country | US
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Telephone | 517-614-4632
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Fax |
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Authorized Official
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Title or Position | MENTAL HEALTH THERAPIST
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Name | ALLISON DENNIS
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Credential | LMSW
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Telephone | 616-541-4507
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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