1972976652 NPI number — LIFE TRANSFORMATION COUNSELING, LLC

Table of content: (NPI 1972976652)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972976652 NPI number — LIFE TRANSFORMATION COUNSELING, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIFE TRANSFORMATION COUNSELING, LLC
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:
1972976652
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/04/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2000 W PIONEER PKWY
Provider Second Line Business Mailing Address:
SUITE 7B
Provider Business Mailing Address City Name:
PEORIA
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61615-1835
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
309-363-1400
Provider Business Mailing Address Fax Number:
309-409-1662

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2000 W PIONEER PKWY
Provider Second Line Business Practice Location Address:
SUITE 7B
Provider Business Practice Location Address City Name:
PEORIA
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61615-1835
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
309-363-1400
Provider Business Practice Location Address Fax Number:
309-409-1662
Provider Enumeration Date:
11/04/2015

Additional Information

Authorized Official

Authorized Official Last Name:
HOWARD
Authorized Official First Name:
QUEENA
Authorized Official Middle Name:
LOUISE
Authorized Official Title or Position:
CLINICIAN/OWNER
Authorized Official Telephone Number:
309-363-1400

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  180007518 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com