| Life & Health Services | |
|
1814 Cumberland Avenue Middlesboro KY 40965 | |
| (606) 242-2519 | |
| (606) 242-2520 |
| Full Name | Life & Health Services |
|---|---|
| Speciality | Psychologist |
| Location | 1814 Cumberland Avenue, Middlesboro, Kentucky |
| Authorized Official Name and Position | Tina T Poore (SECRETARY) |
| Authorized Official Contact | 6062422519 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Life & Health Services 1814 Cumberland Avenue Middlesboro KY 40965 Ph: (606) 242-2519 | Life & Health Services 1814 Cumberland Avenue Middlesboro KY 40965 Ph: (606) 242-2519 |
| NPI Number | 1568864734 |
|---|---|
| Provider Enumeration Date | 09/19/2014 |
| Last Update Date | 08/31/2016 |
| Medicare PECOS PAC ID | 9931410057 |
|---|---|
| Medicare Enrollment ID | O20150616002106 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568864734 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 800179 (Kentucky) | Primary |
| 261QR0405X | Clinic/center - Rehabilitation, Substance Use Disorder | 40049 (Kentucky) | Secondary |
| Provider Name | Mazhar Salim |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1013075449 PECOS PAC ID: 4789775842 Enrollment ID: I20070806000004 |
| Provider Name | Grace C Runions |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104200864 PECOS PAC ID: 2668766098 Enrollment ID: I20160809000249 |
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Life & Health Counseling Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1814 Cumberland Ave, Middlesboro, KY 40965 Phone: 606-242-2519 Fax: 606-242-2520 |