Provider Demographics
NPI:1598452070
Name:VERG LIFE LLC
Entity Type:Organization
Organization Name:VERG LIFE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:AMYE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:GOURLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:219-707-8523
Mailing Address - Street 1:11060 E DIVISION RD
Mailing Address - Street 2:
Mailing Address - City:KNOX
Mailing Address - State:IN
Mailing Address - Zip Code:46534-8733
Mailing Address - Country:US
Mailing Address - Phone:219-707-8523
Mailing Address - Fax:219-707-8523
Practice Address - Street 1:11060 E DIVISION RD
Practice Address - Street 2:
Practice Address - City:KNOX
Practice Address - State:IN
Practice Address - Zip Code:46534-8733
Practice Address - Country:US
Practice Address - Phone:219-707-8523
Practice Address - Fax:219-707-8523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-24
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty