1649567934 NPI number — LIFE CHANGING SUPPORT SERVICES INC.

Table of content: MARISA KATHERINE GONZALES LPC (NPI 1053856500)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649567934 NPI number — LIFE CHANGING SUPPORT SERVICES INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIFE CHANGING SUPPORT SERVICES INC.
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:
1649567934
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/07/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 622
Provider Second Line Business Mailing Address:
112 ST. BENEDICT ST
Provider Business Mailing Address City Name:
CARROLLTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15722
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-330-3694
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
112 ST. BENEDICT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARROLLTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15722
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-330-3694
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/07/2011

Additional Information

Authorized Official

Authorized Official Last Name:
STILES
Authorized Official First Name:
SARAH
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
814-330-3694

Provider Taxonomy Codes

  • Taxonomy code: 320600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 320900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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