Provider Demographics
NPI:1174878599
Name:COUNSELING AND PSYCHOTHERAPY FOR LIFE LLC
Entity type:Organization
Organization Name:COUNSELING AND PSYCHOTHERAPY FOR LIFE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ OPERATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:F
Authorized Official - Last Name:BOAN
Authorized Official - Suffix:
Authorized Official - Credentials:EDS LMFT
Authorized Official - Phone:732-664-0772
Mailing Address - Street 1:19 N COUNTY LINE RD
Mailing Address - Street 2:BLDG 3 SUITE 6
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-1255
Mailing Address - Country:US
Mailing Address - Phone:732-664-0772
Mailing Address - Fax:732-928-6290
Practice Address - Street 1:7 NICOLE CT
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:NJ
Practice Address - Zip Code:08527-2400
Practice Address - Country:US
Practice Address - Phone:732-664-0772
Practice Address - Fax:732-928-6290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-23
Last Update Date:2012-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NJNJ37FI00166800106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty