Provider Demographics
NPI:1700480308
Name:AMAZING LIFE, LLC
Entity type:Organization
Organization Name:AMAZING LIFE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST / OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:DACID
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:270-904-4945
Mailing Address - Street 1:384 RED BIRD TRL
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-0727
Mailing Address - Country:US
Mailing Address - Phone:270-791-5933
Mailing Address - Fax:270-499-7510
Practice Address - Street 1:351 PASCOE BLVD STE 102
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-6302
Practice Address - Country:US
Practice Address - Phone:270-904-4945
Practice Address - Fax:270-499-7510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health