MEDICARE: LIFE COACH PSYCHOLOGY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1023317161
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFE COACH PSYCHOLOGY

Provider Business Mailing Address
First Line	:	9067 US HIGHWAY 31
Second Line	:
City	:	BERRIEN SPRINGS
State	:	MI
Zip	:	49103-1664
Country	:	US
Telephone Number	:	269-815-5331
Fax Number	:	269-815-5061

Provider Business Practice Location Address
First Line	:	9067 US HIGHWAY 31
Second Line	:
City	:	BERRIEN SPRINGS
State	:	MI
Zip	:	49103-1664
Country	:	US
Telephone Number	:	269-815-5331
Fax Number	:	269-815-5061

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. HAROLD B SMITH
Credential	:	PSY.D.
Telephone Number	:	269-815-8531

Provider Enumeration Date	:	03/15/2011
Last Update Date	:	03/15/2011

Similar Medicare Providers

1003881533 — DR. HAROLD B SMITH PYS.D.
Practice Location Address:

9067 US HIGHWAY 31
BERRIEN SPRINGS, MI
49103-1664

Practice Phone: 269-277-0549
Practice Fax:

1639387707 — MS. BETTY W. ULMANIS LMT, CMMMT, NCTMB
Practice Location Address:

9067 US HIGHWAY 31 , SUITE #209
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1245543370 — LIFE COACH PSYCHOLOGY
Practice Location Address:

9067 US HIGHWAY 31 , SUITE 203
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Practice Fax:

1700186418 — MRS. SHARON TASI
Practice Location Address:

9067 US HIGHWAY 31 , SUITE # 209
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49103-1664

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1740588052 — DENISE DIANE SCHMIDTMCCLINTOCK MSW LLSW
Practice Location Address:

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1861703233 — THOMAS ANDREW EHMKE D.O.
Practice Location Address:

4700 GILBERT AVE STE 51
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Practice Phone: 708-387-1737
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Directions to “LIFE COACH PSYCHOLOGY ” Practice Location

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