Provider Demographics
NPI:1124595004
Name:LIFE COUNSELING AND WELLNESS CENTER
Entity Type:Organization
Organization Name:LIFE COUNSELING AND WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SUBSTANCE USE COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:PALOMO
Authorized Official - Suffix:
Authorized Official - Credentials:LADC, ICADC, AA
Authorized Official - Phone:308-631-9357
Mailing Address - Street 1:1516 21ST AVE
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361-2736
Mailing Address - Country:US
Mailing Address - Phone:308-631-9357
Mailing Address - Fax:
Practice Address - Street 1:1516 21ST AVE
Practice Address - Street 2:
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-2736
Practice Address - Country:US
Practice Address - Phone:308-631-9357
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-29
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility