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General NPI Number Information
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NPI Number | 1740773381
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Entity Type | Organization
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Legal Business Name | LIFE PATHWAYS COUNSELING AND COACHING, LLC
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Dates
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Enumeration Date | 06/08/2018
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Last Update Date | 02/23/2024
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Provider Practice Location Address
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Address Line | 4139 W WALTON BLVD STE D
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City | WATERFORD
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State | MI
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Zip | 48329-4187
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Country | US
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Telephone | 248-599-7590
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Fax | 844-270-3954
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Provider Business Mailing Address
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Address Line | 4139 W WALTON BLVD STE D
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City | WATERFORD
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State | MI
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Zip | 48329-4187
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Country | US
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Telephone | 248-599-7590
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Fax | 844-270-3954
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | MRS. MARTHA E GERECKE
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Credential | MA, LPC
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Telephone | 248-599-7590
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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 | 6401013173
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License Number State | MI
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