Provider Demographics
NPI:1710224779
Name:LIFEMOR INC.
Entity Type:Organization
Organization Name:LIFEMOR INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:GRANT
Authorized Official - Last Name:GATES
Authorized Official - Suffix:
Authorized Official - Credentials:MA LPCC DMIN
Authorized Official - Phone:480-370-0227
Mailing Address - Street 1:875 S ESTRELLA PKWY UNIT 6573
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-8563
Mailing Address - Country:US
Mailing Address - Phone:480-370-0227
Mailing Address - Fax:505-814-5740
Practice Address - Street 1:875 S ESTRELLA PKWY UNIT 6573
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-8563
Practice Address - Country:US
Practice Address - Phone:480-370-0227
Practice Address - Fax:505-814-5740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-10
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0083441101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty