Healthcare Provider Details

I. General information

NPI: 1225889892
Provider Name (Legal Business Name): LIFE PSYCHIATRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2024
Last Update Date: 04/01/2024
Certification Date: 03/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6336 PICCADILLY SQUARE DR
MOBILE AL
36609-5143
US

IV. Provider business mailing address

6336 PICCADILLY SQUARE DR
MOBILE AL
36609-5143
US

V. Phone/Fax

Practice location:
  • Phone: 251-999-5433
  • Fax:
Mailing address:
  • Phone: 251-999-5433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MARY DIAZ
Title or Position: OWNER
Credential:
Phone: 917-699-4298