Healthcare Provider Details

I. General information

NPI: 1366503633
Provider Name (Legal Business Name): LIFESPAN PSYCHOLOGICAL SERVICES, PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 09/26/2025
Certification Date: 09/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11290 SUNRISE DR NE SUITE B
BAINBRIDGE ISLAND WA
98110-1353
US

IV. Provider business mailing address

11290 SUNRISE DR NE STE B
BAINBRIDGE ISLAND WA
98110-1353
US

V. Phone/Fax

Practice location:
  • Phone: 206-780-7782
  • Fax: 206-780-1964
Mailing address:
  • Phone: 206-780-7782
  • Fax: 206-780-1964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: STEVEN ERIC CURTIS
Title or Position: PRESIDENT
Credential: PHD
Phone: 206-780-7782