Provider Demographics
NPI:1407469141
Name:LIFE SEASONS COUNSELING, LLC
Entity Type:Organization
Organization Name:LIFE SEASONS COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FARRA
Authorized Official - Middle Name:
Authorized Official - Last Name:CRISWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-347-6310
Mailing Address - Street 1:116 N COLUMBIA ST
Mailing Address - Street 2:
Mailing Address - City:PONTOTOC
Mailing Address - State:MS
Mailing Address - Zip Code:38863-2002
Mailing Address - Country:US
Mailing Address - Phone:662-347-6310
Mailing Address - Fax:
Practice Address - Street 1:116 N COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:PONTOTOC
Practice Address - State:MS
Practice Address - Zip Code:38863-2002
Practice Address - Country:US
Practice Address - Phone:662-347-6310
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health