Provider Demographics
NPI:1831552645
Name:LIFE TREE COUNSELING CENTER INCS
Entity type:Organization
Organization Name:LIFE TREE COUNSELING CENTER INCS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-S, CEAP
Authorized Official - Phone:972-234-6634
Mailing Address - Street 1:14679 MIDWAY RD STE 200
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-3196
Mailing Address - Country:US
Mailing Address - Phone:972-234-6634
Mailing Address - Fax:972-234-6648
Practice Address - Street 1:14679 MIDWAY RD STE 200
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-3196
Practice Address - Country:US
Practice Address - Phone:972-234-6634
Practice Address - Fax:972-234-6648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-30
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX75436261QM0850X, 261QM0855X, 261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health