Provider Demographics
NPI:1093122483
Name:LIFE TRANSFORMATION COUNSELING
Entity Type:Organization
Organization Name:LIFE TRANSFORMATION COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR AND HEAD COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:SUE WEST
Authorized Official - Last Name:SOUTHWARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-280-2474
Mailing Address - Street 1:29149 CHAPEL PARK DR
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33543-4423
Mailing Address - Country:US
Mailing Address - Phone:813-280-2474
Mailing Address - Fax:813-341-5511
Practice Address - Street 1:29149 CHAPEL PARK DR
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33543-4423
Practice Address - Country:US
Practice Address - Phone:813-280-2474
Practice Address - Fax:813-341-5511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-17
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH 7823101Y00000X
261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty