| Life Source Llc | |
|
127 W Main St Ste B-2 Hamilton MT 59840-2581 | |
| (770) 354-9621 | |
| Not Available |
| Full Name | Life Source Llc |
|---|---|
| Speciality | Counselor - Professional |
| Location | 127 W Main St Ste B-2, Hamilton, Montana |
| Authorized Official Name and Position | Fred Michael Huskey (THERAPIST--PARTNER) |
| Authorized Official Contact | 4063605481 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Life Source Llc Po Box 127 Hamilton MT 59840-0127 Ph: (770) 354-9621 | Life Source Llc 127 W Main St Ste B-2 Hamilton MT 59840-2581 Ph: (770) 354-9621 |
| NPI Number | 1922510890 |
|---|---|
| Provider Enumeration Date | 10/31/2017 |
| Last Update Date | 10/31/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922510890 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | 387-LCPC (Montana) | Primary |
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