Provider Demographics
NPI:1538673819
Name:LIFE'SJOURNEY COUNSELING LLC
Entity Type:Organization
Organization Name:LIFE'SJOURNEY COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TAMI
Authorized Official - Middle Name:
Authorized Official - Last Name:BOBBETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-667-1473
Mailing Address - Street 1:313 E CURTIS ST
Mailing Address - Street 2:
Mailing Address - City:MARCELINE
Mailing Address - State:MO
Mailing Address - Zip Code:64658-1613
Mailing Address - Country:US
Mailing Address - Phone:660-676-8500
Mailing Address - Fax:888-978-1973
Practice Address - Street 1:313 E CURTIS ST
Practice Address - Street 2:
Practice Address - City:MARCELINE
Practice Address - State:MO
Practice Address - Zip Code:64658-1613
Practice Address - Country:US
Practice Address - Phone:660-676-8500
Practice Address - Fax:888-978-1973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-26
Last Update Date:2017-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1700274602Medicaid