Provider Demographics
NPI:1770961229
Name:TREE OF LIFE BEHAVIORAL HEALTH
Entity type:Organization
Organization Name:TREE OF LIFE BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:LORENA
Authorized Official - Last Name:PENOT
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC
Authorized Official - Phone:256-278-2802
Mailing Address - Street 1:190 LIME QUARRY RD STE 111
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-8975
Mailing Address - Country:US
Mailing Address - Phone:256-278-2802
Mailing Address - Fax:256-375-0744
Practice Address - Street 1:190 LIME QUARRY RD STE 111
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-8975
Practice Address - Country:US
Practice Address - Phone:256-278-2802
Practice Address - Fax:256-375-0744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-15
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health