Provider Demographics
NPI:1194562728
Name:LBA SERVICES LLC
Entity type:Organization
Organization Name:LBA SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWERS-MOULTRIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-437-9835
Mailing Address - Street 1:607 BRYCE DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80910-3219
Mailing Address - Country:US
Mailing Address - Phone:719-437-9835
Mailing Address - Fax:
Practice Address - Street 1:2301 E PIKES PEAK AVE STE 203
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-8007
Practice Address - Country:US
Practice Address - Phone:719-437-9835
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-11
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty