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General NPI Number Information
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NPI Number | 1770037111
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Entity Type | Organization
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Legal Business Name | LIFEWISE INC.
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Dates
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Enumeration Date | 08/14/2016
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Last Update Date | 08/14/2016
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Provider Practice Location Address
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Address Line | 2009 GLENVIEW AVE
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City | LOUISVILLE
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State | KY
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Zip | 40222-6345
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Country | US
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Telephone | 502-426-1616
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Fax | 502-290-8889
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Provider Business Mailing Address
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Address Line | 2009 GLENVIEW AVE
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City | LOUISVILLE
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State | KY
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Zip | 40222-6345
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Country | US
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Telephone | 502-426-1616
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Fax | 502-290-8889
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JAN ANDERSON
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Credential | PSYD, LPCC
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Telephone | 502-426-1616
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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 | 0222
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License Number State | KY
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