Provider Demographics
NPI:1407365430
Name:LIFE SKILLS AWARENESS
Entity Type:Organization
Organization Name:LIFE SKILLS AWARENESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/LPCC
Authorized Official - Prefix:MS
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:R
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:760-949-1200
Mailing Address - Street 1:15353 BONANZA RD STE 2
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92392-2465
Mailing Address - Country:US
Mailing Address - Phone:760-552-4440
Mailing Address - Fax:760-657-2408
Practice Address - Street 1:15353 BONANZA RD STE 2
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92392-2465
Practice Address - Country:US
Practice Address - Phone:760-552-4440
Practice Address - Fax:760-657-2408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-21
Last Update Date:2017-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health