MEDICARE: LIFECARE MENTAL HEALTH SERVICES, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	171M00000X	Case Manager/Care Coordinator
2	363L00000X	Nurse Practitioner
3	101Y00000X	Counselor
4	101YM0800X	Mental Health Counselor
5	1041C0700X	Clinical Social Worker
6	363LF0000X	Family Nurse Practitioner
7	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1396337291
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFECARE MENTAL HEALTH SERVICES, LLC

Provider Business Mailing Address
First Line	:	8772 BLACKMAN RD
Second Line	:
City	:	KINGSLEY
State	:	MI
Zip	:	49649-9646
Country	:	US
Telephone Number	:	231-944-5907
Fax Number	:

Provider Business Practice Location Address
First Line	:	1323 LYDIA ST
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40217-1536
Country	:	US
Telephone Number	:	502-509-1342
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER/PRINCIPAL THERAPIST
Name	:	MATTHEW WHITE
Credential	:	LMFT, MDIV
Telephone Number	:	502-509-1342

Provider Enumeration Date	:	02/11/2021
Last Update Date	:	04/10/2023

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