MEDICARE: THIRD LIFE CONSULTING, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	172V00000X	Community Health Worker
2	101YA0400X	Addiction (Substance Use Disorder) Counselor
3	171M00000X	Case Manager/Care Coordinator
4	101YP2500X	Professional Counselor
5	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1164312179
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THIRD LIFE CONSULTING, LLC

Provider Business Mailing Address
First Line	:	400 LAPALCO BLVD STE H
Second Line	:
City	:	GRETNA
State	:	LA
Zip	:	70056-7372
Country	:	US
Telephone Number	:	504-224-0903
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 LAPALCO BLVD STE H
Second Line	:
City	:	GRETNA
State	:	LA
Zip	:	70056-7372
Country	:	US
Telephone Number	:	504-224-0903
Fax Number	:

Authorized Official
Title or Position	:	PRINCIPAL CONSULTANT
Name	:	DEMETRIUS RAYFORD
Credential	:	RCP
Telephone Number	:	504-224-0903

Provider Enumeration Date	:	07/09/2025
Last Update Date	:	06/09/2026

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