Provider Demographics
NPI:1821769548
Name:PURPOSED LIFE COUNSELING SERVICES
Entity Type:Organization
Organization Name:PURPOSED LIFE COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KRISTY
Authorized Official - Middle Name:LORENE
Authorized Official - Last Name:BURKS
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:616-745-7507
Mailing Address - Street 1:8 E BRIDGE ST STE D1
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-1601
Mailing Address - Country:US
Mailing Address - Phone:616-745-7507
Mailing Address - Fax:
Practice Address - Street 1:8 E BRIDGE ST STE D1
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:MI
Practice Address - Zip Code:49341-1601
Practice Address - Country:US
Practice Address - Phone:616-745-7507
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-22
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty