Provider Demographics
NPI:1164753265
Name:LIFE CHOICES COUNSELING
Entity Type:Organization
Organization Name:LIFE CHOICES COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:ILLSLEY
Authorized Official - Last Name:PAGENKOPF
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:218-937-5569
Mailing Address - Street 1:900 HIGHWAY 34 E
Mailing Address - Street 2:SUITE B103
Mailing Address - City:DETROIT LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:56501-2643
Mailing Address - Country:US
Mailing Address - Phone:218-937-5569
Mailing Address - Fax:
Practice Address - Street 1:900 HIGHWAY 34 E
Practice Address - Street 2:SUITE B102
Practice Address - City:DETROIT LAKES
Practice Address - State:MN
Practice Address - Zip Code:56501-2643
Practice Address - Country:US
Practice Address - Phone:218-937-5569
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-29
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty