Provider Demographics
NPI:1669340881
Name:LIFELINE BEHAVIOR CONSULTING LLC
Entity type:Organization
Organization Name:LIFELINE BEHAVIOR CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KALYN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:305-322-3557
Mailing Address - Street 1:2848 RED OAK DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32277-3439
Mailing Address - Country:US
Mailing Address - Phone:305-322-3557
Mailing Address - Fax:
Practice Address - Street 1:2848 RED OAK DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32277-3439
Practice Address - Country:US
Practice Address - Phone:305-322-3557
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-28
Last Update Date:2025-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty