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General NPI Number Information
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NPI Number | 1679929996
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Entity Type | Organization
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Legal Business Name | LIFE SKILLS TRAINING AND EDUCATIONAL PROGRAMS, INC.
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Dates
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Enumeration Date | 05/05/2016
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Last Update Date | 05/05/2016
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Provider Practice Location Address
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Address Line | 4041 BRIDGE ST
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City | FAIR OAKS
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State | CA
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Zip | 95628-7503
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Country | US
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Telephone | 916-965-0110
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Fax | 916-965-0102
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Provider Business Mailing Address
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Address Line | 4041 BRIDGE ST
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City | FAIR OAKS
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State | CA
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Zip | 95628-7503
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Country | US
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Telephone | 916-965-0110
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Fax | 916-965-0102
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. ELIZABETH A SOUTHORN
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Credential | M.A.
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Telephone | 916-965-0110
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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