LIFESPAN PSYCHOTHERAPY


Address: 510 Hartbrook Dr Ste 204b, Hartland, WI 53029-1440
Phone: 1262361427

LIFESPAN PSYCHOTHERAPY (NPI# 1841809878) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1841809878
Entity Type Organization
Organization Name LIFESPAN PSYCHOTHERAPY
Practice Address 510 Hartbrook Dr Ste 204b
Hartland
WI 53029-1440
Practice Telephone 1262361427
Practice Fax Number 2623130038
Mailing Telephone 1262361427
Mailing Fax Number 2623130038
Enumeration Date 2020-07-27
Last Update Date 2020-07-27
Authorized Official Name CHRIS A DROSDICK (PSYCHOTHERAPIST)
Authorized Official Telephone 2623614275
Authorized Official Credential MA NCC, CSAC, AT
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 261QM0801X Clinic/Center
Specialization: Mental Health (Including Community Mental Health Center)
Ambulatory Health Care Facilities

Other Provider Identifier

State Issuer Identifier Type Code
WI 1528364825 05

Other Provider/Organization Names

Other Name Type Code
Lifespan Psychotherapy Doing Business As Name - Organization

Office Location

Street Address 510 HARTBROOK DR STE 204B
City HARTLAND
State WI
Zip Code 53029-1440

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1528313384 Kristina Johnson Physical Therapist 600 Hartbrook Dr Ste 111, Hartland, WI 53029 2012-07-18
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Taxonomy Information

Taxonomy Code 261QM0801X
Grouping Ambulatory Health Care Facilities
Classification Clinic/Center
Specialization Mental Health (Including Community Mental Health Center)

Taxonomy Definition

Definition to come...

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Competitor

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City HARTLAND
Zip Code 53029

Improve Information

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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