OrganizationLife And Trauma Survivor Center LlcCounselorBehavioral Health & Social Service ProvidersPractice Address402 Wall St Ste 42, Valparaiso, IN 46383-2572(219) 510-8043PECOS EnrollmentBased on the most recent information from CMS, provider Life And Trauma Survivor Center Llc does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records today at 11:05 AM.Profile DetailsProvider ID1619432119Provider TypeOrganizationFull NameLife And Trauma Survivor Center LlcSubpartNoEnumeration Date2/8/2019Last Updated11/4/2024Contact InformationPractice LocationPractice Address402 Wall St Ste 42, Valparaiso, IN 46383-2572Phone(219) 510-8043Fax(219) 241-8044Mailing LocationMailing Address402 Wall St Ste 42, Valparaiso, IN 46383-2572Phone(219) 510-8043Fax(219) 510-8044Authorized OfficialNameShivok, Sherrie Ann (Owner)Phone(219) 241-0212Provider TaxonomiesCodeDescriptionLicenseCode101YM0800XPrimaryDescriptionCounselorBehavioral Health & Social Service ProvidersLicenseUnlisted IssuerCode1041C0700XDescriptionSocial WorkerBehavioral Health & Social Service ProvidersLicenseUnlisted Issuer