MEDICARE: NEWLIFE FOR YOU SUPPORT 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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1982573531
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEWLIFE FOR YOU SUPPORT LLC

Provider Business Mailing Address
First Line	:	132 SUNSET RDG
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36108-4747
Country	:	US
Telephone Number	:	334-600-1302
Fax Number	:

Provider Business Practice Location Address
First Line	:	4171 LOMAC ST STE F9
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36106-2945
Country	:	US
Telephone Number	:	334-600-1302
Fax Number	:

Authorized Official
Title or Position	:	CHIEF OPERATING OFFICER
Name	:	GYLLANE CLARK
Credential	:
Telephone Number	:	334-425-4837

Provider Enumeration Date	:	11/03/2025
Last Update Date	:	12/26/2025

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Directions to “NEWLIFE FOR YOU SUPPORT LLC ” Practice Location

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