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General NPI Number Information
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NPI Number | 1972201556
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Entity Type | Organization
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Legal Business Name | LET THERE BE LIFE THERAPY
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Dates
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Enumeration Date | 02/22/2023
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Last Update Date | 02/22/2023
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Provider Practice Location Address
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Address Line | 672 W 11TH ST STE 378
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City | TRACY
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State | CA
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Zip | 95376-3821
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Country | US
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Telephone | 209-855-0290
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Fax |
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Provider Business Mailing Address
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Address Line | 672 W 11TH ST STE 378
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City | TRACY
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State | CA
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Zip | 95376-3821
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Country | US
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Telephone | 209-855-0290
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MATTIE SPIRES-PEPPERS
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Credential | LMFT
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Telephone | 209-855-0290
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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 |
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License Number State |
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