Basic Information
| Provider Information | |||||||||
| NPI: | 1164090650 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LIFENESS COUNSELING, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 144 NEWHOUSE ST | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 011182510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4132312181 | ||||||||
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| Practice Location | |||||||||
| Address1: | 15 BENTON DR STE 11 | ||||||||
| Address2: | |||||||||
| City: | EAST LONGMEADOW | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010283232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4132812152 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2021 | ||||||||
| LastUpdateDate: | 06/11/2021 | ||||||||
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| AuthorizedOfficialLastName: | LARA | ||||||||
| AuthorizedOfficialFirstName: | WENDY | ||||||||
| AuthorizedOfficialMiddleName: | STEPHANIE | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER, MENTAL HEALTH COUNSELOR | ||||||||
| AuthorizedOfficialTelephone: | 4132312181 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.ED, LMHC | ||||||||
| NPICertificationDate: | 06/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.