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General NPI Number Information
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NPI Number | 1710224779
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Entity Type | Organization
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Legal Business Name | LIFEMOR INC.
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Dates
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Enumeration Date | 01/10/2013
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Last Update Date | 12/18/2023
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Provider Practice Location Address
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Address Line | 875 S ESTRELLA PKWY UNIT 6573
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City | GOODYEAR
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State | AZ
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Zip | 85338-8563
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Country | US
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Telephone | 480-370-0227
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Fax | 505-814-5740
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Provider Business Mailing Address
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Address Line | 875 S ESTRELLA PKWY UNIT 6573
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City | GOODYEAR
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State | AZ
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Zip | 85338-8563
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Country | US
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Telephone | 480-370-0227
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Fax | 505-814-5740
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ROBERT GRANT GATES
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Credential | M.A. LPCC. DMIN
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Telephone | 480-370-0227
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 0083441
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License Number State | NM
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