Provider Demographics
NPI:1538515028
Name:GOOD LIFE COUNSELING & SUPPORT LLC
Entity Type:Organization
Organization Name:GOOD LIFE COUNSELING & SUPPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR/OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MILLARD
Authorized Official - Suffix:
Authorized Official - Credentials:LIMHP, CPC
Authorized Official - Phone:402-371-3044
Mailing Address - Street 1:2420 15TH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NE
Mailing Address - Zip Code:68601-5021
Mailing Address - Country:US
Mailing Address - Phone:402-371-3044
Mailing Address - Fax:402-371-9643
Practice Address - Street 1:2420 15TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68601-5021
Practice Address - Country:US
Practice Address - Phone:402-371-3044
Practice Address - Fax:402-371-9643
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GOOD LIFE COUNSELING & SUPPORT LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-05-13
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty