MEDICARE: LIFE TRANSFORMATION COUNSELING

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	101Y00000X	Counselor	IMH 7823	FL

General Provider Information

NPI Number	:	1093122483
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFE TRANSFORMATION COUNSELING

Provider Business Mailing Address
First Line	:	29149 CHAPEL PARK DR
Second Line	:
City	:	WESLEY CHAPEL
State	:	FL
Zip	:	33543-4423
Country	:	US
Telephone Number	:	813-280-2474
Fax Number	:	813-341-5511

Provider Business Practice Location Address
First Line	:	29149 CHAPEL PARK DR
Second Line	:
City	:	WESLEY CHAPEL
State	:	FL
Zip	:	33543-4423
Country	:	US
Telephone Number	:	813-280-2474
Fax Number	:	813-341-5511

Authorized Official
Title or Position	:	DIRECTOR AND HEAD COUNSELOR
Name	:	MRS. NATALIE SUE WEST SOUTHWARD
Credential	:
Telephone Number	:	813-280-2474

Provider Enumeration Date	:	07/17/2014
Last Update Date	:	01/21/2021

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