Provider Demographics
NPI:1902521628
Name:LIFE EXAMINED LLC
Entity Type:Organization
Organization Name:LIFE EXAMINED LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/AUTHORIZED OFFICIAL
Authorized Official - Prefix:MS
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:KATHLEEN
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:603-545-9386
Mailing Address - Street 1:PO BOX 521
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:NH
Mailing Address - Zip Code:03849-0521
Mailing Address - Country:US
Mailing Address - Phone:603-545-9386
Mailing Address - Fax:
Practice Address - Street 1:90 ODELL HILL RD
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:NH
Practice Address - Zip Code:03818-4401
Practice Address - Country:US
Practice Address - Phone:603-545-9386
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-05
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty