Provider Demographics
NPI:1659504132
Name:LIFE SOLUTIONS PROFESSIONAL COUNSELING CENTER
Entity Type:Organization
Organization Name:LIFE SOLUTIONS PROFESSIONAL COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OUTPATIENT THERAPIST/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MANCHES
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC, NCC
Authorized Official - Phone:724-415-9555
Mailing Address - Street 1:68 LEBANON AVE
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15401-4127
Mailing Address - Country:US
Mailing Address - Phone:724-415-9555
Mailing Address - Fax:724-439-5433
Practice Address - Street 1:68 LEBANON AVE
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401-4127
Practice Address - Country:US
Practice Address - Phone:724-415-9555
Practice Address - Fax:724-439-5433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-31
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC004484251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1679793525OtherNPPES AS AN INDIVIDUAL PROVIDER