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General NPI Number Information
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NPI Number | 1831179266
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Entity Type | Organization
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Legal Business Name | LIFE ENRICHMENT CENTER LLC
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Dates
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Enumeration Date | 01/20/2006
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Last Update Date | 02/03/2019
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Provider Practice Location Address
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Address Line | 2619 W 6TH ST STE G
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City | LAWRENCE
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State | KS
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Zip | 66049-4300
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Country | US
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Telephone | 785-842-2752
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Fax | 785-842-2750
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Provider Business Mailing Address
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Address Line | 4000 W 6TH ST # 130
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City | LAWRENCE
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State | KS
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Zip | 66049-3204
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Country | US
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Telephone | 785-842-2752
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Fax | 785-842-2750
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Authorized Official
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Title or Position | PARTNER
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Name | MR. EDWARD C BLOCH
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Credential | LSCSW
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Telephone | 785-842-2752
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCS 2132
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LCMFT 246
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License Number State | KS
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