1326740564 NPI number — TREE OF LIFE COUNSELING AND MINISTRIES

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326740564 NPI number — TREE OF LIFE COUNSELING AND MINISTRIES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TREE OF LIFE COUNSELING AND MINISTRIES
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:
TREE OF LIFE COUNSELING CENTER AND FOUNDATION
Provider Other Organization Name Type Code:
3
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:
1326740564
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/15/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14896 FAVERSHAM CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32826-4106
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-358-7188
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 S CENTRAL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OVIEDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32765-9027
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-358-7188
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/21/2023

Additional Information

Authorized Official

Authorized Official Last Name:
LESLIE
Authorized Official First Name:
DAMELIS
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
407-542-4430

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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