Provider Demographics
NPI:1154515153
Name:CENTER FOR LIFE COACHING AND COUNSELING, LLC
Entity type:Organization
Organization Name:CENTER FOR LIFE COACHING AND COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:C
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC, NCC
Authorized Official - Phone:417-671-9856
Mailing Address - Street 1:491 CHARITY SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:CRANE
Mailing Address - State:MO
Mailing Address - Zip Code:65633-8179
Mailing Address - Country:US
Mailing Address - Phone:417-671-9856
Mailing Address - Fax:417-671-9881
Practice Address - Street 1:1401 S ELLIOTT AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:MO
Practice Address - Zip Code:65605-2103
Practice Address - Country:US
Practice Address - Phone:417-671-9856
Practice Address - Fax:417-671-9881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-02
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO101YP2500X251S00000X
MO2006009253251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO490749108Medicaid
MO1346370616OtherNPI, INDIVIDUAL
MO501336705Medicaid