MEDICARE: LIFEWAY MENTAL HEALTH COUNSELING SERVICES PLLC

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	101YM0800X	Mental Health Counselor	005864-1	NY

General Provider Information

NPI Number	:	1821526336
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFEWAY MENTAL HEALTH COUNSELING SERVICES PLLC

Provider Business Mailing Address
First Line	:	2426 STATE ROUTE 11 STE A
Second Line	:
City	:	NORTH BANGOR
State	:	NY
Zip	:	12966-2747
Country	:	US
Telephone Number	:	518-521-8869
Fax Number	:

Provider Business Practice Location Address
First Line	:	2426 STATE ROUTE 11 STE A
Second Line	:
City	:	NORTH BANGOR
State	:	NY
Zip	:	12966-2747
Country	:	US
Telephone Number	:	518-521-8869
Fax Number	:

Authorized Official
Title or Position	:	SOLE MEMBER
Name	:	JULIA LOUISE SCHROEN
Credential	:
Telephone Number	:	518-521-8869

Provider Enumeration Date	:	05/28/2017
Last Update Date	:	07/21/2022

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