Provider Demographics
NPI:1073377487
Name:COMMUNITY LIFE COUNSELING
Entity Type:Organization
Organization Name:COMMUNITY LIFE COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:HARDCASTLE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:254-865-9911
Mailing Address - Street 1:407 HIGHWAY 36 BYP N STE 1
Mailing Address - Street 2:
Mailing Address - City:GATESVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76528-4680
Mailing Address - Country:US
Mailing Address - Phone:254-865-9911
Mailing Address - Fax:254-865-9912
Practice Address - Street 1:407 HIGHWAY 36 BYP N STE 1
Practice Address - Street 2:
Practice Address - City:GATESVILLE
Practice Address - State:TX
Practice Address - Zip Code:76528-4680
Practice Address - Country:US
Practice Address - Phone:254-865-9911
Practice Address - Fax:254-865-9912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-07
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty