Healthcare Provider Details

I. General information

NPI: 1710641543
Provider Name (Legal Business Name): LIFETREE BEHAVIORAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2021
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16587 ENTERPRISE DR STE E
THREE RIVERS MI
49093-7902
US

IV. Provider business mailing address

16587 ENTERPRISE DR STE E
THREE RIVERS MI
49093-7902
US

V. Phone/Fax

Practice location:
  • Phone: 213-864-1870
  • Fax: 269-421-0830
Mailing address:
  • Phone: 213-864-1870
  • Fax: 269-421-0830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DANA PELLEGRINO
Title or Position: CEO
Credential: LBA, BCBA-D
Phone: 213-864-1870