Healthcare Provider Details

I. General information

NPI: 1497510028
Provider Name (Legal Business Name): LIFEWORKS PSYCHIATRIC CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2024
Last Update Date: 11/26/2024
Certification Date: 11/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 WILLOW LN
JASPER AL
35503-6122
US

IV. Provider business mailing address

3608 HIGHWAY 78 E
JASPER AL
35501-8909
US

V. Phone/Fax

Practice location:
  • Phone: 205-717-6050
  • Fax: 205-892-9272
Mailing address:
  • Phone: 205-717-6050
  • Fax: 205-892-9272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MS. MIRANDA SHAE CODY
Title or Position: PMHNP-BC
Credential: PMHNP-BC
Phone: 205-717-6050