Provider Demographics
NPI:1114228335
Name:LIFESONG FOR GROWTH AND WELLNESS LLC
Entity Type:Organization
Organization Name:LIFESONG FOR GROWTH AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:MIDDLETON
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LCSW
Authorized Official - Phone:573-644-7909
Mailing Address - Street 1:3401 W TRUMAN BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65109-5752
Mailing Address - Country:US
Mailing Address - Phone:573-644-7909
Mailing Address - Fax:573-644-7908
Practice Address - Street 1:3401 W TRUMAN BLVD
Practice Address - Street 2:STE 100
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-5752
Practice Address - Country:US
Practice Address - Phone:573-644-7909
Practice Address - Fax:573-644-7908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-04
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty