Provider Demographics
NPI:1720457542
Name:LIFE SKILLS KID THERAPY INC.
Entity type:Organization
Organization Name:LIFE SKILLS KID THERAPY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NEBLETT
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:305-910-3247
Mailing Address - Street 1:1411 SAWGRASS CORPORATE PKWY
Mailing Address - Street 2:SUITE B20
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-2888
Mailing Address - Country:US
Mailing Address - Phone:954-237-1903
Mailing Address - Fax:888-557-6906
Practice Address - Street 1:1411 SAWGRASS CORPORATE PKWY
Practice Address - Street 2:SUITE B20
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33323-2888
Practice Address - Country:US
Practice Address - Phone:954-237-1903
Practice Address - Fax:888-557-6906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-22
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018811100Medicaid