Provider Demographics
NPI:1811388721
Name:NULIFE THERAPY SERVICES, LLC
Entity Type:Organization
Organization Name:NULIFE THERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOTHERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLEE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, SAC
Authorized Official - Phone:262-210-4839
Mailing Address - Street 1:6214 WASHINGTON AVE
Mailing Address - Street 2:SUITE C-3
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:WI
Mailing Address - Zip Code:53406-3986
Mailing Address - Country:US
Mailing Address - Phone:262-456-3712
Mailing Address - Fax:262-672-4147
Practice Address - Street 1:6214 WASHINGTON AVE
Practice Address - Street 2:SUITE C-3
Practice Address - City:MOUNT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53406-3986
Practice Address - Country:US
Practice Address - Phone:262-456-3712
Practice Address - Fax:262-672-4147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-13
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2816125251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39735200Medicaid