Provider Demographics
NPI:1003234907
Name:SPRING OF LIFE FAMILY SERVICES LLC
Entity Type:Organization
Organization Name:SPRING OF LIFE FAMILY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:KINYUY
Authorized Official - Last Name:LANGE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:405-414-0043
Mailing Address - Street 1:7814 NORTHWEST 94TH, SUITE B
Mailing Address - Street 2:
Mailing Address - City:OKC
Mailing Address - State:OK
Mailing Address - Zip Code:73162-6201
Mailing Address - Country:US
Mailing Address - Phone:405-414-0043
Mailing Address - Fax:
Practice Address - Street 1:7814 NW 94TH ST STE B
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73162-6203
Practice Address - Country:US
Practice Address - Phone:405-414-0043
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-29
Last Update Date:2014-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4942251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health