Provider Demographics
NPI:1427829308
Name:CONNECTED LIFE VENTURES
Entity type:Organization
Organization Name:CONNECTED LIFE VENTURES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAYLIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RENTFRO
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:940-435-2789
Mailing Address - Street 1:500 HILLCREST LN
Mailing Address - Street 2:
Mailing Address - City:KRUM
Mailing Address - State:TX
Mailing Address - Zip Code:76249-5170
Mailing Address - Country:US
Mailing Address - Phone:806-676-6196
Mailing Address - Fax:
Practice Address - Street 1:500 HILLCREST LN
Practice Address - Street 2:
Practice Address - City:KRUM
Practice Address - State:TX
Practice Address - Zip Code:76249-5170
Practice Address - Country:US
Practice Address - Phone:806-676-6196
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-10
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty