| Organization Name: | LIFESPAN COUNSELING CENTER LLC |
| NPI Number: | 1093157778 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DORIS MARIE HALLAM (OWNER/COUNSELOR) |
| Mailing Address: | 450 Cumberland Way Ste A Sullivan |
| State: | MO US |
| Postal Code: | 630803325 |
| Phone Number: | 5734682121 |
| Fax Number: | 5734686121 |
| NPI Enumeration Date: | 07/23/2013 |
| NPI Last Update Date: | 07/23/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 2008012437 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |