Life Source LLC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

387-LCPC Issued in MT

Legal business name

LIFE SOURCE LLC

Practice address

127 W Main St Ste B-2
Hamilton, MT 59840-2581

Phone

(770) 354-9621

NPI assigned

Oct 31, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Fred Michael Huskey, LCPC/CMHP

Title

Therapist--Partner

Phone

(406) 360-5481

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1509408000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1509408000000",
    "number": "1922510890",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 127",
            "city": "HAMILTON",
            "state": "MT",
            "postal_code": "598400127",
            "telephone_number": "770-354-9621"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "127 W MAIN ST STE B-2",
            "city": "HAMILTON",
            "state": "MT",
            "postal_code": "598402581",
            "telephone_number": "770-354-9621"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE SOURCE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-31",
        "last_updated": "2017-10-31",
        "status": "A",
        "authorized_official_last_name": "HUSKEY",
        "authorized_official_first_name": "FRED",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "THERAPIST--PARTNER",
        "authorized_official_telephone_number": "406-360-5481",
        "authorized_official_credential": "LCPC/CMHP"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Professional",
            "state": "MT",
            "license": "387-LCPC",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Professional Counselor in Hamilton, MT
• Providers in Hamilton, MT by specialty
• Professional Counselor in Montana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.