Healthcare Provider Details

I. General information

NPI: 1861373235
Provider Name (Legal Business Name): LIFEBOAT THERAPY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2025
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13601 S 44TH ST APT 2022
PHOENIX AZ
85044-4885
US

IV. Provider business mailing address

13601 S 44TH ST APT 2022
PHOENIX AZ
85044-4885
US

V. Phone/Fax

Practice location:
  • Phone: 517-518-0859
  • Fax:
Mailing address:
  • Phone: 517-518-0859
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number State

VIII. Authorized Official

Name: SAMANTHA RYAN KLEIN
Title or Position: OWNER
Credential: MT-BC
Phone: 517-518-0859