Provider Demographics
NPI:1871196675
Name:LIFE CRAFTERS, LLC
Entity Type:Organization
Organization Name:LIFE CRAFTERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:MADISON
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:859-630-7760
Mailing Address - Street 1:369 W VINE ST APT 1906
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40507-1697
Mailing Address - Country:US
Mailing Address - Phone:859-630-7760
Mailing Address - Fax:
Practice Address - Street 1:535 W SECOND ST STE L110
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40508-9002
Practice Address - Country:US
Practice Address - Phone:859-630-7760
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-16
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty