Provider Demographics
NPI:1720309115
Name:LIFE ENRICHMENT COUNSELING SERVICE LLC
Entity type:Organization
Organization Name:LIFE ENRICHMENT COUNSELING SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:AUSTIN-DANNER
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:407-399-6311
Mailing Address - Street 1:7991 CANYON LAKE CIR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-5383
Mailing Address - Country:US
Mailing Address - Phone:407-399-6311
Mailing Address - Fax:407-298-6618
Practice Address - Street 1:1515 PARK CENTER DR
Practice Address - Street 2:SUITE 2M
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-5794
Practice Address - Country:US
Practice Address - Phone:407-399-6311
Practice Address - Fax:407-730-4636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-20
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW54441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1699005298OtherNPPES--INDIVIDUAL NPI NUMBER
FLDC118AMedicare PIN
FL1699005298OtherNPPES--INDIVIDUAL NPI NUMBER