Provider Demographics
NPI:1518400837
Name:LIFE COUNSELING AND CONSULTING, PLLC
Entity type:Organization
Organization Name:LIFE COUNSELING AND CONSULTING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LIFE COUNSELING AND
Authorized Official - Middle Name:CONSULTING
Authorized Official - Last Name:PLLC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-941-6660
Mailing Address - Street 1:831 ROYAL GORGE BLVD
Mailing Address - Street 2:SUITE 217
Mailing Address - City:CANON CITY
Mailing Address - State:CO
Mailing Address - Zip Code:81212-6709
Mailing Address - Country:US
Mailing Address - Phone:719-722-2722
Mailing Address - Fax:719-452-3752
Practice Address - Street 1:831 ROYAL GORGE BLVD
Practice Address - Street 2:SUITE 217
Practice Address - City:CANON CITY
Practice Address - State:CO
Practice Address - Zip Code:81212-6709
Practice Address - Country:US
Practice Address - Phone:719-722-2722
Practice Address - Fax:719-452-3752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-18
Last Update Date:2017-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACD40000646101YA0400X
COCSW099236041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty