Provider Demographics
NPI:1912356783
Name:LIFE TRANSITIONS COUNSELING CENTER, LLC
Entity Type:Organization
Organization Name:LIFE TRANSITIONS COUNSELING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:260-434-1606
Mailing Address - Street 1:4630 W JEFFERSON BLVD
Mailing Address - Street 2:#11A
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-6856
Mailing Address - Country:US
Mailing Address - Phone:260-434-1606
Mailing Address - Fax:260-434-1606
Practice Address - Street 1:4630 W JEFFERSON BLVD
Practice Address - Street 2:#11A
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-6856
Practice Address - Country:US
Practice Address - Phone:260-434-1606
Practice Address - Fax:260-434-1606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-12
Last Update Date:2016-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20042044A103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty