Provider Demographics
NPI:1003473448
Name:PSYCHOLOGY SPECIALISTS LTD
Entity Type:Organization
Organization Name:PSYCHOLOGY SPECIALISTS LTD
Other - Org Name:LIFESTANCE HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING SPECIALISTS
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-527-1571
Mailing Address - Street 1:PO BOX 8204
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91109-8204
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:801 S RANCHO DR STE A2
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-3870
Practice Address - Country:US
Practice Address - Phone:702-805-5360
Practice Address - Fax:309-663-2995
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PSYCHOLOGY SPECIALISTS LTD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-05-21
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVPY0777OtherLICENSE