Provider Demographics
NPI:1558488858
Name:LIFE ENCOURAGEMENT OUTREACH
Entity type:Organization
Organization Name:LIFE ENCOURAGEMENT OUTREACH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPC
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:JUNIPER
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:304-781-6712
Mailing Address - Street 1:2400 JOHNSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-4738
Mailing Address - Country:US
Mailing Address - Phone:304-781-6712
Mailing Address - Fax:304-522-6382
Practice Address - Street 1:2400 JOHNSTOWN RD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-4738
Practice Address - Country:US
Practice Address - Phone:304-781-6712
Practice Address - Fax:304-522-6382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health