1356627020 NPI number — NEW LIFE COUNSELING

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 1356627020 NPI number — NEW LIFE COUNSELING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW LIFE COUNSELING
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:
1356627020
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/26/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1536
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HANNIBAL
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63401-1536
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-221-3356
Provider Business Mailing Address Fax Number:
573-221-5373

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9155 COUNTY ROAD 404
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HANNIBAL
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63401-6530
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-221-3356
Provider Business Practice Location Address Fax Number:
573-221-5373
Provider Enumeration Date:
10/26/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WALDEN
Authorized Official First Name:
BRAD
Authorized Official Middle Name:
WESLEY
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
573-221-3356

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YS0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 102L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041S0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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