Provider Demographics
NPI:1770037111
Name:LIFEWISE INC.
Entity Type:Organization
Organization Name:LIFEWISE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, LPCC
Authorized Official - Phone:502-426-1616
Mailing Address - Street 1:2009 GLENVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-6345
Mailing Address - Country:US
Mailing Address - Phone:502-426-1616
Mailing Address - Fax:502-290-8889
Practice Address - Street 1:2009 GLENVIEW AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-6345
Practice Address - Country:US
Practice Address - Phone:502-426-1616
Practice Address - Fax:502-290-8889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-14
Last Update Date:2016-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0222101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty