Provider Demographics
NPI:1821526336
Name:LIFEWAY MENTAL HEALTH COUNSELING SERVICES PLLC
Entity Type:Organization
Organization Name:LIFEWAY MENTAL HEALTH COUNSELING SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:SCHROEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-521-8869
Mailing Address - Street 1:2426 STATE ROUTE 11 STE A
Mailing Address - Street 2:
Mailing Address - City:NORTH BANGOR
Mailing Address - State:NY
Mailing Address - Zip Code:12966-2747
Mailing Address - Country:US
Mailing Address - Phone:518-521-8869
Mailing Address - Fax:
Practice Address - Street 1:2426 STATE ROUTE 11 STE A
Practice Address - Street 2:
Practice Address - City:NORTH BANGOR
Practice Address - State:NY
Practice Address - Zip Code:12966-2747
Practice Address - Country:US
Practice Address - Phone:518-521-8869
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005864-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty