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General NPI Number Information
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NPI Number | 1861944977
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Entity Type | Organization
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Legal Business Name | FUNCTIONAL LIFESTYLE SYSTEMS INC
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Dates
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Enumeration Date | 10/25/2016
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Last Update Date | 12/13/2023
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Provider Practice Location Address
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Address Line | 503 REMINGTON ST STE 102
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City | FORT COLLINS
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State | CO
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Zip | 80524-3089
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Country | US
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Telephone | 970-690-9592
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Fax | 970-353-7888
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Provider Business Mailing Address
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Address Line | 1303 31ST AVE
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City | GREELEY
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State | CO
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Zip | 80634-6327
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Country | US
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Telephone | 970-690-9592
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Fax | 970-353-7888
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. LORI A. PERRIN
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Credential | PH.D.
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Telephone | 970-690-9592
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 2243
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License Number State | CO
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