Healthcare Provider Details

I. General information

NPI: 1508345521
Provider Name (Legal Business Name): LIFE SOLUTIONS SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2018
Last Update Date: 09/20/2022
Certification Date: 09/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 OAKFIELD DR STE 206
BRANDON FL
33511-4954
US

IV. Provider business mailing address

122 HICKORY CREEK BLVD
BRANDON FL
33511-8061
US

V. Phone/Fax

Practice location:
  • Phone: 754-800-3261
  • Fax:
Mailing address:
  • Phone: 754-800-3261
  • Fax: 813-689-3815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW9563
License Number StateFL

VIII. Authorized Official

Name: JENNIFER ALLEN
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 813-361-7927