Provider Demographics
NPI:1588311922
Name:LIFESPAN COUNSELING SERVICES LLC
Entity type:Organization
Organization Name:LIFESPAN COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:CASCIATO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-214-8267
Mailing Address - Street 1:14952 NEWPORT RD
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33764-7085
Mailing Address - Country:US
Mailing Address - Phone:172-721-4826
Mailing Address - Fax:727-475-8965
Practice Address - Street 1:14952 NEWPORT RD
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33764-7085
Practice Address - Country:US
Practice Address - Phone:727-214-8267
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-06
Last Update Date:2022-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC230172637890OtherDRIVER'S LICENSE