Provider Demographics
NPI:1326212770
Name:LIFETIME BEHAVIORAL HEALTH, LLC
Entity type:Organization
Organization Name:LIFETIME BEHAVIORAL HEALTH, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC, NCC
Authorized Official - Phone:630-525-0025
Mailing Address - Street 1:550 E WASHINGTON ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:WEST CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60185-2228
Mailing Address - Country:US
Mailing Address - Phone:630-525-0025
Mailing Address - Fax:
Practice Address - Street 1:550 E WASHINGTON ST
Practice Address - Street 2:SUITE A
Practice Address - City:WEST CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60185-2228
Practice Address - Country:US
Practice Address - Phone:630-525-0025
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty