Provider Demographics
NPI:1003562299
Name:LIFESPAN BEHAVIORAL HEALTH SERVICES PC
Entity Type:Organization
Organization Name:LIFESPAN BEHAVIORAL HEALTH SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:SUSSAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-982-3437
Mailing Address - Street 1:1003 W 7TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-4106
Mailing Address - Country:US
Mailing Address - Phone:301-245-6300
Mailing Address - Fax:
Practice Address - Street 1:1003 W 7TH ST STE 200
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-4106
Practice Address - Country:US
Practice Address - Phone:301-245-6300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIFESPAN BEHAVIORAL HEALTH SERVICES PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-02-25
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)