MEDICARE: LIFE GUIDANCE, 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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	212390	PA

General Provider Information

NPI Number	:	1386703601
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFE GUIDANCE, LLC

Provider Business Mailing Address
First Line	:	225 PARKVIEW AVE
Second Line	:
City	:	ALLENTOWN
State	:	PA
Zip	:	18104-5323
Country	:	US
Telephone Number	:	610-435-5334
Fax Number	:	610-419-3446

Provider Business Practice Location Address
First Line	:	934 DELAWARE AVE
Second Line	:
City	:	FOUNTAIN HILL
State	:	PA
Zip	:	18015-2567
Country	:	US
Telephone Number	:	610-865-1699
Fax Number	:	610-419-3446

Authorized Official
Title or Position	:	OWNER
Name	:	MS. LUPE PEARCE
Credential	:
Telephone Number	:	610-435-5334

Provider Enumeration Date	:	12/06/2006
Last Update Date	:	07/07/2020

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