Organization
LIFE ENRICHMENT CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. EDWARD C BLOCH LSCSW (PARTNER)
(785) 842-2752
Entity
Organization
Contact information
Practice address
2619 W 6TH ST STE G, LAWRENCE, KS 66049-4300
(785) 842-2752
(785) 842-2750
Mailing address
4000 W 6TH ST # 130, LAWRENCE, KS 66049-3204
(785) 842-2752
(785) 842-2750
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
LCS 2132
KS
106H00000X
Marriage & Family Therapist
Primary
LCMFT 246
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
180505
BLUE CROSS BLUE SHIELD
KS
05
—
200655570A
—
KS
Enumeration date
01/20/2006
Last updated
02/03/2019
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