Provider Demographics
NPI:1114262235
Name:LIFE QUEST MINISTRY INC
Entity Type:Organization
Organization Name:LIFE QUEST MINISTRY INC
Other - Org Name:LIFE QUEST COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:A
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:MA LPC
Authorized Official - Phone:816-765-8211
Mailing Address - Street 1:12505 GRANDVIEW RD
Mailing Address - Street 2:
Mailing Address - City:GRANDVIEW
Mailing Address - State:MO
Mailing Address - Zip Code:64030-1703
Mailing Address - Country:US
Mailing Address - Phone:816-765-8211
Mailing Address - Fax:816-765-8215
Practice Address - Street 1:12505 GRANDVIEW RD
Practice Address - Street 2:
Practice Address - City:GRANDVIEW
Practice Address - State:MO
Practice Address - Zip Code:64030-1703
Practice Address - Country:US
Practice Address - Phone:816-765-8211
Practice Address - Fax:816-765-8215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-29
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001013216101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty