Provider Demographics
NPI:1023317161
Name:LIFE COACH PSYCHOLOGY
Entity type:Organization
Organization Name:LIFE COACH PSYCHOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:B
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:269-815-8531
Mailing Address - Street 1:9067 US HIGHWAY 31
Mailing Address - Street 2:
Mailing Address - City:BERRIEN SPRINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49103-1664
Mailing Address - Country:US
Mailing Address - Phone:269-815-5331
Mailing Address - Fax:269-815-5061
Practice Address - Street 1:9067 US HIGHWAY 31
Practice Address - Street 2:
Practice Address - City:BERRIEN SPRINGS
Practice Address - State:MI
Practice Address - Zip Code:49103-1664
Practice Address - Country:US
Practice Address - Phone:269-815-5331
Practice Address - Fax:269-815-5061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-15
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health