Healthcare Provider Details

I. General information

NPI: 1982977120
Provider Name (Legal Business Name): LIFE SOULUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2012
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

427 NE 3RD ST STE C
CRYSTAL RIVER FL
34429
US

IV. Provider business mailing address

209 HAMMOCK RD
INGLIS FL
34449-9542
US

V. Phone/Fax

Practice location:
  • Phone: 352-586-3877
  • Fax:
Mailing address:
  • Phone: 352-586-3877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberMH10446
License Number StateFL

VIII. Authorized Official

Name: TRINA SCALF
Title or Position: COUNSELOR
Credential: M.A.
Phone: 352-586-3877