Provider Demographics
NPI:1932841673
Name:TREE OF LIFE INC
Entity Type:Organization
Organization Name:TREE OF LIFE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:A
Authorized Official - Last Name:JONNES-KUCA
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:605-310-1099
Mailing Address - Street 1:5000 S MAC ARTHUR LN STE 104
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-5407
Mailing Address - Country:US
Mailing Address - Phone:605-310-1099
Mailing Address - Fax:
Practice Address - Street 1:5000 S MAC ARTHUR LN STE 104
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-5407
Practice Address - Country:US
Practice Address - Phone:605-310-1099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-12
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty