Provider Demographics
NPI:1528352176
Name:LIFES JOURNEY COUNSELING SERVICES
Entity type:Organization
Organization Name:LIFES JOURNEY COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:RENNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHASTAIN-PEPPARS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW LCSW
Authorized Official - Phone:816-262-4494
Mailing Address - Street 1:1724 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64505-1811
Mailing Address - Country:US
Mailing Address - Phone:816-262-4494
Mailing Address - Fax:816-364-4737
Practice Address - Street 1:1724 8TH AVE
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64505-1811
Practice Address - Country:US
Practice Address - Phone:816-262-4494
Practice Address - Fax:816-364-4737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-31
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0013471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
36358018OtherBCBS
MO493517619Medicaid
36358018OtherBCBS