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NPI Code Detail

MEDICARE: LIFESPARK PLLC

MEDICARE: LIFESPARK PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TA0700XAdult Development & Aging Psychologist
2103TF0200XForensic Psychologist
3103TC0700XClinical Psychologist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11407328214OTHERNPPES ORGANIZATIONAL NPI FOR MEANINGFUL LIVING LLC
21912478108OTHERNPPES INDIVIDUAL NPI

General Provider Information

NPI Number : 1396217816
Entity Type Code : Organization
Provider Name (Legal Business Name) : LIFESPARK PLLC
Provider Business Mailing Address
First Line : 118 PUBLIC SQ
Second Line :
City : GALLATIN
State : TN
Zip : 37066-2803
Country : US
Telephone Number : 615-442-6229
Fax Number : 615-675-0026
Provider Business Practice Location Address
First Line : 118 PUBLIC SQ
Second Line :
City : GALLATIN
State : TN
Zip : 37066-2803
Country : US
Telephone Number : 615-442-6229
Fax Number : 615-675-0026
Authorized Official
Title or Position : CEO
Name : DR. JASON HOLLAND
Credential : PHD
Telephone Number : 615-442-6229
Provider Enumeration Date : 12/21/2018
Last Update Date : 03/12/2026

Similar Medicare Providers

1407328214 — MEANINGFUL LIVING, LLC
Practice Location Address:
118 PUBLIC SQ
GALLATIN, TN
37066-2803
Practice Phone: 415-702-8240
Practice Fax:
1912478108 — JASON HOLLAND PH.D.
Practice Location Address:
118 PUBLIC SQ
GALLATIN, TN
37066-2803
Practice Phone: 615-442-6229
Practice Fax: 615-675-0026
1013863786 — MS. CYNTHIA CAROL MACDONALD CNM
Practice Location Address:
300 STEAM PLANT RD STE 270
GALLATIN, TN
37066-3019
Practice Phone: 615-328-3390
Practice Fax:
1972506145 — MR. STEPHEN MATTHEW ROSE M.D.
Practice Location Address:
270 E MAIN ST
GALLATIN, TN
37066-2990
Practice Phone: 615-675-2000
Practice Fax: 615-278-1672
1699770016 — RAYMOND B DEMOVILLE MD
Practice Location Address:
1525 HUNT CLUB BLVD STE 100
GALLATIN, TN
37066-6070
Practice Phone: 615-822-2177
Practice Fax: 615-822-0300
1861498313 — DR. MARC E HOFMANN M.D.
Practice Location Address:
300 STEAM PLANT RD STE 100A
GALLATIN, TN
37066-3056
Practice Phone: 615-328-4720
Practice Fax: 615-328-6973

Directions to “LIFESPARK PLLC ” Practice Location

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