Provider Demographics
NPI:1649578980
Name:LIFE STAGE THERAPY
Entity Type:Organization
Organization Name:LIFE STAGE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:MORSE
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:505-710-4259
Mailing Address - Street 1:3301 COORS BLVD NW STE R
Mailing Address - Street 2:SUITE 148
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-1268
Mailing Address - Country:US
Mailing Address - Phone:505-710-4259
Mailing Address - Fax:
Practice Address - Street 1:3301 COORS BLVD NW STE R
Practice Address - Street 2:SUITE 148
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-1268
Practice Address - Country:US
Practice Address - Phone:505-710-4259
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-10
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0248101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty