Provider Demographics
NPI:1053085704
Name:LIFELIGHT COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:LIFELIGHT COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RACHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:GUSAAS
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:763-614-7148
Mailing Address - Street 1:1030 COUNTY ROAD E W STE 220
Mailing Address - Street 2:
Mailing Address - City:SHOREVIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55126-8153
Mailing Address - Country:US
Mailing Address - Phone:763-340-2310
Mailing Address - Fax:
Practice Address - Street 1:1030 COUNTY ROAD E W
Practice Address - Street 2:
Practice Address - City:SHOREVIEW
Practice Address - State:MN
Practice Address - Zip Code:55126-8152
Practice Address - Country:US
Practice Address - Phone:763-340-2310
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-05
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center