Provider Demographics
NPI:1194285643
Name:LIFELINE PROFESSIONAL COUNSELING SERVICES, INC
Entity type:Organization
Organization Name:LIFELINE PROFESSIONAL COUNSELING SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:DELORENZO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-641-1165
Mailing Address - Street 1:335 N ALMA SCHOOL RD STE E
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-4363
Mailing Address - Country:US
Mailing Address - Phone:480-641-1165
Mailing Address - Fax:480-641-9026
Practice Address - Street 1:1423 S HIGLEY RD STE 103
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-3449
Practice Address - Country:US
Practice Address - Phone:480-641-1165
Practice Address - Fax:480-641-9026
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIFELINE PROFESSIONAL COUNSELING SERVICES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-03-21
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)