Provider Demographics
NPI:1902402373
Name:NEW LIFE OPTIONS COUNSELING SERVICES LLC
Entity Type:Organization
Organization Name:NEW LIFE OPTIONS COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:CADC
Authorized Official - Phone:815-672-1802
Mailing Address - Street 1:205 S PARK ST STE 3
Mailing Address - Street 2:
Mailing Address - City:STREATOR
Mailing Address - State:IL
Mailing Address - Zip Code:61364-4448
Mailing Address - Country:US
Mailing Address - Phone:815-672-1802
Mailing Address - Fax:815-672-1860
Practice Address - Street 1:205 S PARK ST STE 3
Practice Address - Street 2:
Practice Address - City:STREATOR
Practice Address - State:IL
Practice Address - Zip Code:61364-4448
Practice Address - Country:US
Practice Address - Phone:815-672-1802
Practice Address - Fax:815-672-1860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-09
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health