Organization Name: | LIFE QUEST MINISTRY INC |
NPI Number: | 1114262235 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | KEITH A WHITE (VICE-PRESIDENT) |
Mailing Address: | 12505 Grandview Rd Grandview |
State: | MO US |
Postal Code: | 640301703 |
Phone Number: | 8167658211 |
Fax Number: | 8167658215 |
NPI Enumeration Date: | 11/29/2012 |
NPI Last Update Date: | 11/29/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 2001013216 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |