Provider Demographics
NPI:1831179266
Name:LIFE ENRICHMENT CENTER LLC
Entity type:Organization
Organization Name:LIFE ENRICHMENT CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:C
Authorized Official - Last Name:BLOCH
Authorized Official - Suffix:
Authorized Official - Credentials:LSCSW
Authorized Official - Phone:785-842-2752
Mailing Address - Street 1:4000 W 6TH ST # 130
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-3204
Mailing Address - Country:US
Mailing Address - Phone:785-842-2752
Mailing Address - Fax:785-842-2750
Practice Address - Street 1:2619 W 6TH ST STE G
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-4300
Practice Address - Country:US
Practice Address - Phone:785-842-2752
Practice Address - Fax:785-842-2750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-20
Last Update Date:2019-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLCS 21321041C0700X
KSLCMFT 246106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS180505OtherBLUE CROSS BLUE SHIELD
KS200655570AMedicaid
KS200655570AMedicaid