Provider Demographics
NPI:1831819143
Name:LIFE WITHOUT FLAWS
Entity type:Organization
Organization Name:LIFE WITHOUT FLAWS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST, PROF. COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORRAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:MASTER'S DEGREE
Authorized Official - Phone:616-259-5112
Mailing Address - Street 1:719 ARDMORE ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49507-3258
Mailing Address - Country:US
Mailing Address - Phone:616-780-7664
Mailing Address - Fax:616-971-6157
Practice Address - Street 1:2180 44TH ST SE STE 301
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49508-5093
Practice Address - Country:US
Practice Address - Phone:616-259-5112
Practice Address - Fax:616-259-5112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty