MEDICARE: BEAUTIFUL LIFE COUNSELING SERVICES, 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437613056
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEAUTIFUL LIFE COUNSELING SERVICES, LLC

Provider Business Mailing Address
First Line	:	1413 CALHOUN ST STE 140
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29201-2562
Country	:	US
Telephone Number	:	803-727-5774
Fax Number	:	903-807-2561

Provider Business Practice Location Address
First Line	:	1413 CALHOUN ST STE 140
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29201-2562
Country	:	US
Telephone Number	:	803-727-5774
Fax Number	:	903-807-2561

Authorized Official
Title or Position	:	OWNER/LPC
Name	:	ALISA E WEESE
Credential	:	LPC
Telephone Number	:	803-727-5774

Provider Enumeration Date	:	01/28/2019
Last Update Date	:	01/28/2019

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