Healthcare Provider Details

I. General information

NPI: 1720457542
Provider Name (Legal Business Name): LIFE SKILLS KID THERAPY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2015
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 BARTOW RD
LAKELAND FL
33801-5106
US

IV. Provider business mailing address

207 BARTOW RD
LAKELAND FL
33801-5106
US

V. Phone/Fax

Practice location:
  • Phone: 863-360-4910
  • Fax: 863-360-0492
Mailing address:
  • Phone: 863-360-4910
  • Fax: 863-360-4929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: VIJAY DASIKA
Title or Position: CEO
Credential:
Phone: 863-360-4910