Provider Demographics
NPI:1306031257
Name:EXECUTIVE & LIFE COACHING, INC.
Entity Type:Organization
Organization Name:EXECUTIVE & LIFE COACHING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:COLBERT
Authorized Official - Middle Name:BERNARD
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:SR
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:866-726-7881
Mailing Address - Street 1:2058 E OLDFIELD ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93535-1727
Mailing Address - Country:US
Mailing Address - Phone:866-726-7881
Mailing Address - Fax:661-940-9317
Practice Address - Street 1:44709 DATE AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-3101
Practice Address - Country:US
Practice Address - Phone:866-726-7881
Practice Address - Fax:661-940-9317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-12
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS18531251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALCS18531OtherB.B.S.