Provider Demographics
NPI:1750696662
Name:LIFESONG COUNSELING CENTER, LLC
Entity type:Organization
Organization Name:LIFESONG COUNSELING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:LEHNERTZ
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:480-656-8349
Mailing Address - Street 1:1425 W. ELLIOT RD SUITE 207
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-8720
Mailing Address - Country:US
Mailing Address - Phone:480-656-8349
Mailing Address - Fax:
Practice Address - Street 1:1425 W. ELLIOT RD SUITE 207
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-8720
Practice Address - Country:US
Practice Address - Phone:480-656-8349
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-16
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMFT-10262106H00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty