Provider Demographics
NPI:1285348086
Name:LIFE PRACTICE COUNSELING GROUP
Entity type:Organization
Organization Name:LIFE PRACTICE COUNSELING GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CARISA
Authorized Official - Middle Name:SALAZAR
Authorized Official - Last Name:SHERWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT 48768
Authorized Official - Phone:916-798-5468
Mailing Address - Street 1:3820 AUBURN BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95821-2124
Mailing Address - Country:US
Mailing Address - Phone:916-300-6576
Mailing Address - Fax:916-514-1621
Practice Address - Street 1:2787 GROVE AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815-1629
Practice Address - Country:US
Practice Address - Phone:916-300-6576
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIFE PRACTICE COUNSELING GROUP, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-01-06
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty