Basic Information
| Provider Information | |||||||||
| NPI: | 1063708998 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LIFE COUNSELING PROFESSIONAL SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2260 PALM BEACH LAKES BLVD | ||||||||
| Address2: | SUITE 212 | ||||||||
| City: | WEST PALM BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334093411 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8009900340 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5001 S FLORIDA AVE | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | LAKELAND | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338132776 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8009900340 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2011 | ||||||||
| LastUpdateDate: | 06/20/2011 | ||||||||
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| AuthorizedOfficialLastName: | GILBERT | ||||||||
| AuthorizedOfficialFirstName: | DEJA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8009900340 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 320800000X | Y | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness |
No ID Information.