MEDICARE: BEST LIFE COUNSELING SERVICE, LLC

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	101YP2500X	Professional Counselor	6401014645	MI

General Provider Information

NPI Number	:	1174043137
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEST LIFE COUNSELING SERVICE, LLC

Provider Business Mailing Address
First Line	:	25900 GREENFIELD RD STE 411
Second Line	:
City	:	OAK PARK
State	:	MI
Zip	:	48237-1287
Country	:	US
Telephone Number	:	248-965-2747
Fax Number	:	248-965-2749

Provider Business Practice Location Address
First Line	:	25900 GREENFIELD RD STE 411
Second Line	:
City	:	OAK PARK
State	:	MI
Zip	:	48237-1287
Country	:	US
Telephone Number	:	248-965-2747
Fax Number	:	248-965-2749

Authorized Official
Title or Position	:	OWNER/OPERATOR
Name	:	VICKIE WRIGHT
Credential	:	MAC
Telephone Number	:	248-965-2747

Provider Enumeration Date	:	06/21/2017
Last Update Date	:	06/21/2017

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