Provider Demographics
NPI: | 1861669111 |
---|---|
Name: | LIFE SKILLS COUNSELING, INC. |
Entity Type: | Organization |
Organization Name: | LIFE SKILLS COUNSELING, INC. |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CLINICAL DIRECTOR |
Authorized Official - Prefix: | MS |
Authorized Official - First Name: | VIRGINIA |
Authorized Official - Middle Name: | A |
Authorized Official - Last Name: | PERSON |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | LPC |
Authorized Official - Phone: | 623-974-9504 |
Mailing Address - Street 1: | 16901 N BOSWELL BLVD STE B |
Mailing Address - Street 2: | |
Mailing Address - City: | SUN CITY |
Mailing Address - State: | AZ |
Mailing Address - Zip Code: | 85351-1294 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 623-974-9504 |
Mailing Address - Fax: | 623-974-9505 |
Practice Address - Street 1: | 16901 N BOSWELL BLVD STE B |
Practice Address - Street 2: | |
Practice Address - City: | SUN CITY |
Practice Address - State: | AZ |
Practice Address - Zip Code: | 85351-1294 |
Practice Address - Country: | US |
Practice Address - Phone: | 623-974-9504 |
Practice Address - Fax: | 623-974-9505 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2008-05-14 |
Last Update Date: | 2008-05-14 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
AZ | 10841 | 251S00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 251S00000X | Agencies | Community/Behavioral Health |