Provider Demographics
NPI:1972976652
Name:LIFE TRANSFORMATION COUNSELING, LLC
Entity Type:Organization
Organization Name:LIFE TRANSFORMATION COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICIAN/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:QUEENA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:309-363-1400
Mailing Address - Street 1:2000 W PIONEER PKWY
Mailing Address - Street 2:SUITE 7B
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-1835
Mailing Address - Country:US
Mailing Address - Phone:309-363-1400
Mailing Address - Fax:309-409-1662
Practice Address - Street 1:2000 W PIONEER PKWY
Practice Address - Street 2:SUITE 7B
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-1835
Practice Address - Country:US
Practice Address - Phone:309-363-1400
Practice Address - Fax:309-409-1662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-04
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180007518101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty