Provider Demographics
NPI:1073809901
Name:LIFE COUNSELING PROFESSIONAL SERVICES
Entity Type:Organization
Organization Name:LIFE COUNSELING PROFESSIONAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEJA
Authorized Official - Middle Name:
Authorized Official - Last Name:GILBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-990-0340
Mailing Address - Street 1:2260 PALM BEACH LAKES BLVD
Mailing Address - Street 2:SUITE 212
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-3411
Mailing Address - Country:US
Mailing Address - Phone:800-990-0340
Mailing Address - Fax:
Practice Address - Street 1:403 LITHIA PINECREST RD
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-6138
Practice Address - Country:US
Practice Address - Phone:800-990-0340
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-20
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness