Healthcare Provider Details

I. General information

NPI: 1053084533
Provider Name (Legal Business Name): LIFE SKILLS DEVELOPMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2021
Last Update Date: 07/29/2021
Certification Date: 06/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1655 PALM BEACH LAKES BLVD STE 504
WEST PALM BEACH FL
33401-2206
US

IV. Provider business mailing address

1655 PALM BEACH LAKES BLVD STE 504
WEST PALM BEACH FL
33401-2206
US

V. Phone/Fax

Practice location:
  • Phone:
  • Fax:
Mailing address:
  • Phone: 561-255-1577
  • Fax: 561-255-1577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. HEIDI MCFARLANE
Title or Position: I/O PSYCHOLOGIST, COUNSELOR
Credential: PHD
Phone: 561-225-1577