Provider Demographics
NPI:1558184325
Name:PURE LIFE COUNSELING AND TESTING
Entity type:Organization
Organization Name:PURE LIFE COUNSELING AND TESTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNEER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHELBY
Authorized Official - Middle Name:COOK
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:276-206-3040
Mailing Address - Street 1:PO BOX 1791
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:VA
Mailing Address - Zip Code:24354-8689
Mailing Address - Country:US
Mailing Address - Phone:276-206-3040
Mailing Address - Fax:540-527-9810
Practice Address - Street 1:183 RIGBY ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:VA
Practice Address - Zip Code:24354-6342
Practice Address - Country:US
Practice Address - Phone:276-206-3040
Practice Address - Fax:540-527-9810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-01
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health