Provider Demographics
NPI:1487718326
Name:LIFE DEVELOPMENT COUNSELORS
Entity type:Organization
Organization Name:LIFE DEVELOPMENT COUNSELORS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOONE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC
Authorized Official - Phone:417-889-6764
Mailing Address - Street 1:2021 S WAVERLY AVE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-2414
Mailing Address - Country:US
Mailing Address - Phone:417-889-6764
Mailing Address - Fax:417-889-6627
Practice Address - Street 1:2021 S WAVERLY AVE
Practice Address - Street 2:SUITE 500
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-2414
Practice Address - Country:US
Practice Address - Phone:417-889-6764
Practice Address - Fax:417-889-6627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOCS 1086101YM0800X
MO300047106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty