Provider Demographics
NPI:1134455827
Name:LIFESSENTIALS COUNSELING, LLC
Entity type:Organization
Organization Name:LIFESSENTIALS COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/CREDENTIALING
Authorized Official - Prefix:MRS
Authorized Official - First Name:NETTIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:PUTNAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-222-5496
Mailing Address - Street 1:131 N LUDLOW ST
Mailing Address - Street 2:SUITE 1212
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45402-1116
Mailing Address - Country:US
Mailing Address - Phone:937-222-5496
Mailing Address - Fax:937-222-5497
Practice Address - Street 1:131 N LUDLOW ST
Practice Address - Street 2:SUITE 1212
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45402-1116
Practice Address - Country:US
Practice Address - Phone:937-222-5496
Practice Address - Fax:937-222-5497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-30
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0675251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health