=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679374482
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LIFE PSYCHIATRY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/19/2025
-----------------------------------------------------
Last Update Date | 03/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7501 BARFIELD LN
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28037-6403
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-266-2084
-----------------------------------------------------
Fax | 252-422-9274
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1205 MERLOT DR
-----------------------------------------------------
City | PALM BEACH GARDENS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33410-1529
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-266-2084
-----------------------------------------------------
Fax | 252-422-9274
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MD
-----------------------------------------------------
Name | DR. DAVID HUSTED
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 704-266-2084
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------