Provider Demographics
NPI:1841206604
Name:LIFE COUNSELING CENTER INC.
Entity Type:Organization
Organization Name:LIFE COUNSELING CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:A
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:208-465-5433
Mailing Address - Street 1:112 12TH AVE RD
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-5011
Mailing Address - Country:US
Mailing Address - Phone:208-465-5433
Mailing Address - Fax:208-466-5802
Practice Address - Street 1:112 12TH AVE RD
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83686-5051
Practice Address - Country:US
Practice Address - Phone:208-465-5433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID8J745OtherBLUE CROSS OF IDAHO
ID000010153409OtherBLUE CROSS OF IDAHO
ID806994000Medicaid
ID807395800Medicaid