Provider Demographics
NPI:1073054359
Name:LIFE LAUNCH COUNSELING, LLC
Entity Type:Organization
Organization Name:LIFE LAUNCH COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARYANN
Authorized Official - Middle Name:
Authorized Official - Last Name:RIGONI-SOUTHLAND
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:269-743-6139
Mailing Address - Street 1:3030 S 9TH ST STE 3F
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-9456
Mailing Address - Country:US
Mailing Address - Phone:269-743-6139
Mailing Address - Fax:
Practice Address - Street 1:3030 S 9TH ST STE 3F
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-9456
Practice Address - Country:US
Practice Address - Phone:269-743-6139
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-20
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401008766101YP2500X
MI6301011550103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty