# MISTER LIFE COACH

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1619403219
- **Authorized official:** MR. ROBERT GREEN JR. (LIFE COACH)
- **Authorized official phone:** (631) 553-7131

## Contact information

- **Practice address:** 3681 N DECATUR RD APT R11, DECATUR, GA 30032-1062
- **Practice address phone:** (631) 553-7131
- **Mailing address:** PO BOX 283, REX, GA 30273-0283

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 05/03/2017
- **Last updated:** 05/03/2017