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General NPI Number Information
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NPI Number | 1912175217
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Entity Type | Organization
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Legal Business Name | LIFE HEALING CENTER
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Dates
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Enumeration Date | 02/20/2008
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Last Update Date | 02/20/2008
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Provider Practice Location Address
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Address Line | 7155 W CAMPO BELLO DR SUITE B160
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City | GLENDALE
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State | AZ
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Zip | 85308-8590
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Country | US
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Telephone | 623-533-5138
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Fax |
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Provider Business Mailing Address
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Address Line | 7155 W CAMPO BELLO DR SUITE B160
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City | GLENDALE
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State | AZ
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Zip | 85308-8590
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Country | US
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Telephone | 623-533-5138
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | KARRIE ANN CHENEVERT
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Credential | MAPC, LISAC
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Telephone | 623-533-5138
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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