Provider Demographics
NPI:1326304387
Name:LIFEWORKS COUNSELING CENTER
Entity Type:Organization
Organization Name:LIFEWORKS COUNSELING CENTER
Other - Org Name:LONG HOLLOW BAPTIST CHURCH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:615-829-8018
Mailing Address - Street 1:1181 NASHVILLE PIKE
Mailing Address - Street 2:
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-3165
Mailing Address - Country:US
Mailing Address - Phone:615-829-8018
Mailing Address - Fax:615-824-4506
Practice Address - Street 1:1181 NASHVILLE PIKE
Practice Address - Street 2:
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066-3165
Practice Address - Country:US
Practice Address - Phone:615-829-8018
Practice Address - Fax:615-824-4506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-04
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLCSW00000049541041C0700X
TNLMT0000000816106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty