Provider Demographics
NPI:1134967458
Name:MODLIFE COUNSELING, LLC
Entity type:Organization
Organization Name:MODLIFE COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:LEA
Authorized Official - Last Name:LOWEN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:817-381-6333
Mailing Address - Street 1:101 HERITAGE LN
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76087-4422
Mailing Address - Country:US
Mailing Address - Phone:817-381-6333
Mailing Address - Fax:
Practice Address - Street 1:2501 FM 1189 STE 300
Practice Address - Street 2:
Practice Address - City:BROCK
Practice Address - State:TX
Practice Address - Zip Code:76087-5602
Practice Address - Country:US
Practice Address - Phone:817-381-6333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-19
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Multi-Specialty
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchoolGroup - Multi-Specialty