Provider Demographics
NPI:1134524523
Name:TREE OF LIFE COUNSELING, LLC
Entity type:Organization
Organization Name:TREE OF LIFE COUNSELING, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:PLOSKI
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:814-333-8733
Mailing Address - Street 1:924 DIAMOND PARK
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-2605
Mailing Address - Country:US
Mailing Address - Phone:814-333-8733
Mailing Address - Fax:814-333-8733
Practice Address - Street 1:924 DIAMOND PARK
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-2605
Practice Address - Country:US
Practice Address - Phone:814-333-8733
Practice Address - Fax:814-333-8733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-28
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC000870101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPC000870OtherSTATE LICENSE
PA1019289750002Medicaid