Provider Demographics
NPI:1871676619
Name:LIFE HISTORY SERVICES, LLC
Entity Type:Organization
Organization Name:LIFE HISTORY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:
Authorized Official - Last Name:HECHT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:608-255-9669
Mailing Address - Street 1:503 S DICKINSON ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53703-4061
Mailing Address - Country:US
Mailing Address - Phone:608-255-9669
Mailing Address - Fax:
Practice Address - Street 1:503 S DICKINSON ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53703-4061
Practice Address - Country:US
Practice Address - Phone:608-255-9669
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4343-123251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health