Provider Demographics
NPI:1013625334
Name:LIFE COUNSELING LLC
Entity Type:Organization
Organization Name:LIFE COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:SHAUN
Authorized Official - Middle Name:
Authorized Official - Last Name:LOTTER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:417-343-9939
Mailing Address - Street 1:2401 W RICHWOOD RD
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:MO
Mailing Address - Zip Code:65721-6018
Mailing Address - Country:US
Mailing Address - Phone:417-343-9939
Mailing Address - Fax:
Practice Address - Street 1:2135 S EASTGATE AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65809-2146
Practice Address - Country:US
Practice Address - Phone:417-221-6252
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-07
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health