Provider Demographics
NPI:1497292551
Name:LIFE'S JOURNEY COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:LIFE'S JOURNEY COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LEONA
Authorized Official - Middle Name:
Authorized Official - Last Name:TANNER
Authorized Official - Suffix:
Authorized Official - Credentials:LADC
Authorized Official - Phone:918-728-0159
Mailing Address - Street 1:307 W 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:BRISTOW
Mailing Address - State:OK
Mailing Address - Zip Code:74010-2804
Mailing Address - Country:US
Mailing Address - Phone:918-807-5070
Mailing Address - Fax:918-807-5071
Practice Address - Street 1:307 W 4TH AVE
Practice Address - Street 2:
Practice Address - City:BRISTOW
Practice Address - State:OK
Practice Address - Zip Code:74010-2804
Practice Address - Country:US
Practice Address - Phone:918-807-5070
Practice Address - Fax:918-807-5071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-27
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health