Provider Demographics
NPI:1063828432
Name:NEW LIFE COUNSELING SERVICES LLC
Entity Type:Organization
Organization Name:NEW LIFE COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ LCSW
Authorized Official - Prefix:MR
Authorized Official - First Name:CURTIS
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:JONES
Authorized Official - Suffix:JR
Authorized Official - Credentials:LCSW
Authorized Official - Phone:417-536-6058
Mailing Address - Street 1:3350 W KATELLA CT
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-3849
Mailing Address - Country:US
Mailing Address - Phone:417-536-6058
Mailing Address - Fax:417-883-2403
Practice Address - Street 1:3350 W KATELLA CT
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-3849
Practice Address - Country:US
Practice Address - Phone:417-536-6058
Practice Address - Fax:417-883-2403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-07
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20070285861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1144482464Medicaid