Provider Demographics
NPI:1114369493
Name:LIFE COUNSELING CENTER INC
Entity Type:Organization
Organization Name:LIFE COUNSELING CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHIASEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-255-7704
Mailing Address - Street 1:120 W EASTMAN ST STE 305
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-5950
Mailing Address - Country:US
Mailing Address - Phone:847-255-7704
Mailing Address - Fax:
Practice Address - Street 1:120 W EASTMAN ST STE 305
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-5950
Practice Address - Country:US
Practice Address - Phone:847-255-7704
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-26
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.007404101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty