Provider Demographics
NPI:1922174978
Name:LIFE SOLUTIONS, LLC
Entity Type:Organization
Organization Name:LIFE SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ED
Authorized Official - Middle Name:
Authorized Official - Last Name:MELTON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:417-894-2731
Mailing Address - Street 1:PO BOX 1317
Mailing Address - Street 2:512 E. MT VERNON
Mailing Address - City:NIXA
Mailing Address - State:MO
Mailing Address - Zip Code:65714-1317
Mailing Address - Country:US
Mailing Address - Phone:417-725-4930
Mailing Address - Fax:417-725-5149
Practice Address - Street 1:512 E MOUNT VERNON ST
Practice Address - Street 2:
Practice Address - City:NIXA
Practice Address - State:MO
Practice Address - Zip Code:65714-9149
Practice Address - Country:US
Practice Address - Phone:417-725-4930
Practice Address - Fax:417-725-5149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOLC0777679251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO501498901Medicaid