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General NPI Number Information
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NPI Number | 1609004563
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Entity Type | Organization
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Legal Business Name | LIFE SOURCE SOLUTIONS, INC
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Dates
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Enumeration Date | 06/30/2009
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Last Update Date | 06/30/2009
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Provider Practice Location Address
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Address Line | 4107 MISSION INN AVE
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City | RIVERSIDE
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State | CA
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Zip | 92501
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Country | US
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Telephone | 951-682-7143
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Fax | 951-684-1135
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Provider Business Mailing Address
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Address Line | PO BOX 529
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City | RIVERSIDE
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State | CA
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Zip | 92501
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Country | US
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Telephone | 951-682-7143
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Fax | 951-684-1135
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Authorized Official
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Title or Position | OWNER
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Name | MRS. AVIS C ATTAWAY
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Credential | LMFT
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Telephone | 951-522-9370
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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