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General NPI Number Information
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NPI Number | 1669725875
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Entity Type | Organization
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Legal Business Name | LIFE PRACTICE LLC
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Dates
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Enumeration Date | 10/25/2012
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Last Update Date | 10/25/2012
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Provider Practice Location Address
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Address Line | 2006 S WAYNE RD
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City | WESTLAND
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State | MI
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Zip | 48186-5428
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Country | US
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Telephone | 313-799-0093
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Fax | 734-467-3965
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Provider Business Mailing Address
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Address Line | 2006 S WAYNE RD
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City | WESTLAND
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State | MI
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Zip | 48186-5428
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Country | US
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Telephone | 313-799-0093
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Fax | 734-467-3965
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Authorized Official
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Title or Position | THERAPIST
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Name | MS. BETTY ANN RICKMAN
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Credential | LMSW,LPC
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Telephone | 313-799-0093
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 6801035053
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 6401006504
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License Number State | MI
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