MEDICARE: LIFE DEVELOPMENT CENTERS, INCORPORATED

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC1900X	Counseling Psychologist

General Provider Information

NPI Number	:	1114705084
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFE DEVELOPMENT CENTERS, INCORPORATED

Provider Business Mailing Address
First Line	:	9863 ARN DR
Second Line	:
City	:	SUGARCREEK TOWNSHIP
State	:	OH
Zip	:	45458-4144
Country	:	US
Telephone Number	:	937-271-9560
Fax Number	:

Provider Business Practice Location Address
First Line	:	9863 ARN DR
Second Line	:
City	:	SUGARCREEK TOWNSHIP
State	:	OH
Zip	:	45458-4144
Country	:	US
Telephone Number	:	937-271-9560
Fax Number	:

Authorized Official
Title or Position	:	PSYCHOLOGIST/OWNER
Name	:	STEPHEN WAYNE EMERICK
Credential	:	PHD
Telephone Number	:	937-271-9560

Provider Enumeration Date	:	09/20/2023
Last Update Date	:	09/20/2023

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