Basic Information
| Provider Information | |||||||||
| NPI: | 1174759823 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LIFEWORKS COUNSELING AND EDUCATIONAL SERVICES INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2213 GRAND AVE | ||||||||
| Address2: | |||||||||
| City: | DES MOINES | ||||||||
| State: | IA | ||||||||
| PostalCode: | 503125305 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5152373974 | ||||||||
| FaxNumber: | 5158832692 | ||||||||
| Practice Location | |||||||||
| Address1: | 301 N ANKENY BLVD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | ANKENY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 500231730 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5152558399 | ||||||||
| FaxNumber: | 5152558405 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2009 | ||||||||
| LastUpdateDate: | 06/09/2009 | ||||||||
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| AuthorizedOfficialLastName: | STANLEY | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 5152558399 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LISW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 00124 | IA | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 104100000X | 04243 | IA | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.