1528362944 NPI number — LIFE DISCOVERY COUNSELING CENTER

Table of content: (NPI 1528362944)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528362944 NPI number — LIFE DISCOVERY COUNSELING CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIFE DISCOVERY COUNSELING CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528362944
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/28/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 44
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LUTZ
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33548
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-264-8771
Provider Business Mailing Address Fax Number:
813-964-8943

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18371 EXCITING IDLEWILD BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LUTZ
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33548
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-264-8771
Provider Business Practice Location Address Fax Number:
813-964-8943
Provider Enumeration Date:
12/28/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
EATON
Authorized Official First Name:
JOANN
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE ADMINISTRATOR
Authorized Official Telephone Number:
813-264-8771

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  MT2503 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: MH9814 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YM0800X , with the licence number: MH3707 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: MT1854 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)