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Organization
LIFE360 COMMUNITY SERVICES
Active
Organization
LIFE360 COMMUNITY SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GENE ESTRADA GARCIA I MS (COUNSELING SERVICES DIRECTOR)
(417) 658-5409
Entity
Organization
Contact information
Practice address
836 S SUBURBAN AVE, SPRINGFIELD, MO 65802-6774
(417) 658-5409
Mailing address
2220 W CHESTERFIELD BLVD, SPRINGFIELD, MO 65807-8683
(417) 447-9000
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1578916946
—
MO
Enumeration date
07/27/2021
Last updated
03/01/2022
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