MEDICARE: LIFESOURCE FAMILY SOLUTIONS CORP

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
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1699465138
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFESOURCE FAMILY SOLUTIONS CORP

Provider Business Mailing Address
First Line	:	310 COLLOREDO BLVD BLDG B
Second Line	:
City	:	SHELBYVILLE
State	:	TN
Zip	:	37160-2764
Country	:	US
Telephone Number	:	931-488-4480
Fax Number	:

Provider Business Practice Location Address
First Line	:	310 COLLOREDO BLVD BLDG B
Second Line	:
City	:	SHELBYVILLE
State	:	TN
Zip	:	37160-2764
Country	:	US
Telephone Number	:	931-488-4480
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MRS. LAURA LEE TUCKER-HUGGINS
Credential	:	LPC-MHSP
Telephone Number	:	931-212-7227

Provider Enumeration Date	:	05/09/2023
Last Update Date	:	06/02/2026

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