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General NPI Number Information
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NPI Number | 1902802002
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Entity Type | Organization
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Legal Business Name | LIFESTREAM BEHAVIORAL CENTER INC
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Dates
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Enumeration Date | 06/23/2005
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Last Update Date | 07/18/2012
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Provider Practice Location Address
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Address Line | 2020 TALLEY RD
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City | LEESBURG
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State | FL
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Zip | 34748-3426
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Country | US
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Telephone | 352-315-7800
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Fax | 352-315-6595
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Provider Business Mailing Address
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Address Line | PO BOX 491000
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City | LEESBURG
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State | FL
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Zip | 34749-1000
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Country | US
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Telephone | 352-315-7500
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Fax | 352-360-6595
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Authorized Official
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Title or Position | CFO
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Name | MS. CAROL E DOZIER
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Credential | CPA
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Telephone | 352-315-7532
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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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 | 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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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 283Q00000X
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Taxonomy Name | Psychiatric Hospital
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License Number | 4075
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License Number State | FL
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