Provider Demographics
NPI:1770169765
Name:LIFE DISCOVERY SERVICE LLC
Entity type:Organization
Organization Name:LIFE DISCOVERY SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:HALE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:573-837-7144
Mailing Address - Street 1:PO BOX 100
Mailing Address - Street 2:
Mailing Address - City:POCAHONTAS
Mailing Address - State:MO
Mailing Address - Zip Code:63779-0100
Mailing Address - Country:US
Mailing Address - Phone:573-837-7144
Mailing Address - Fax:636-333-4510
Practice Address - Street 1:10672 US HIGHWAY 61
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MO
Practice Address - Zip Code:63755-7171
Practice Address - Country:US
Practice Address - Phone:573-837-7144
Practice Address - Fax:636-333-4510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-22
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty