Provider Demographics
NPI:1861636029
Name:LIFE MANAGEMENT COUNSELING & CONSULTING
Entity Type:Organization
Organization Name:LIFE MANAGEMENT COUNSELING & CONSULTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:GLOVER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:580-351-1188
Mailing Address - Street 1:621 SW D AVE
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73501-4507
Mailing Address - Country:US
Mailing Address - Phone:580-351-1188
Mailing Address - Fax:580-351-1313
Practice Address - Street 1:621 SW D AVE
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73501-4507
Practice Address - Country:US
Practice Address - Phone:580-351-1188
Practice Address - Fax:580-351-1313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-30
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2890251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health