| Lifeplace, Inc. | |
|
1580 S Milwaukee Ave Suite 307 Libertyville IL 60048-3764 | |
| (847) 557-0645 | |
| (847) 557-9809 |
| Full Name | Lifeplace, Inc. |
|---|---|
| Speciality | Counselor |
| Location | 1580 S Milwaukee Ave, Libertyville, Illinois |
| Authorized Official Name and Position | Drew Michael Mjoen (PRESIDENT) |
| Authorized Official Contact | 8475570645 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lifeplace, Inc. 1580 S Milwaukee Ave Suite 307 Libertyville IL 60048-3764 Ph: (847) 557-0645 | Lifeplace, Inc. 1580 S Milwaukee Ave Suite 307 Libertyville IL 60048-3764 Ph: (847) 557-0645 |
| NPI Number | 1588920615 |
|---|---|
| Provider Enumeration Date | 04/03/2012 |
| Last Update Date | 04/03/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588920615 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101Y00000X | Counselor | 180003417 (Illinois) | Primary |
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