Provider Demographics
NPI:1699465138
Name:LIFESOURCE FAMILY SOLUTIONS CORP
Entity type:Organization
Organization Name:LIFESOURCE FAMILY SOLUTIONS CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:TUCKER-HUGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-MHSP
Authorized Official - Phone:931-212-7227
Mailing Address - Street 1:310 COLLOREDO BLVD BLDG B
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37160-2764
Mailing Address - Country:US
Mailing Address - Phone:931-488-4480
Mailing Address - Fax:
Practice Address - Street 1:310 COLLOREDO BLVD BLDG B
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37160-2764
Practice Address - Country:US
Practice Address - Phone:931-488-4480
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-09
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty