Provider Demographics
NPI:1417546367
Name:LIFE QUEST COUNSELING, LLC
Entity Type:Organization
Organization Name:LIFE QUEST COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:SPENCER
Authorized Official - Last Name:HUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:505-297-6616
Mailing Address - Street 1:PO BOX 5522
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87499-5522
Mailing Address - Country:US
Mailing Address - Phone:505-297-6166
Mailing Address - Fax:505-787-2411
Practice Address - Street 1:116 N WALL AVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-6916
Practice Address - Country:US
Practice Address - Phone:505-297-6616
Practice Address - Fax:505-787-2411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-14
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty