Provider Demographics
NPI:1740773381
Name:LIFE PATHWAYS COUNSELING AND COACHING, LLC
Entity Type:Organization
Organization Name:LIFE PATHWAYS COUNSELING AND COACHING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:E
Authorized Official - Last Name:GERECKE
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:248-599-7590
Mailing Address - Street 1:4139 W WALTON BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48329-4187
Mailing Address - Country:US
Mailing Address - Phone:248-599-7590
Mailing Address - Fax:844-270-3954
Practice Address - Street 1:4139 W WALTON BLVD STE D
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48329-4187
Practice Address - Country:US
Practice Address - Phone:248-599-7590
Practice Address - Fax:844-270-3954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-08
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401013173101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty