Provider Demographics
NPI:1669851135
Name:LIFE WALK COUSELING SERVICES
Entity Type:Organization
Organization Name:LIFE WALK COUSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST- OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:L
Authorized Official - Last Name:KAHL
Authorized Official - Suffix:
Authorized Official - Credentials:NCC, CCDP-D, CPRP
Authorized Official - Phone:814-849-4906
Mailing Address - Street 1:115 MABON ST
Mailing Address - Street 2:
Mailing Address - City:BROOKVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15825-1412
Mailing Address - Country:US
Mailing Address - Phone:814-849-4906
Mailing Address - Fax:
Practice Address - Street 1:115 MABON ST
Practice Address - Street 2:
Practice Address - City:BROOKVILLE
Practice Address - State:PA
Practice Address - Zip Code:15825-1412
Practice Address - Country:US
Practice Address - Phone:814-849-4906
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-29
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0185661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PADO NOT HAVE ONEOtherI AM TRYING TO APPLY
PADO NOT HAVE ONE YETOtherI AM TRYING TO APPLY