Provider Demographics
NPI:1083299572
Name:LIFESPAN BEHAVIORAL HEALTH P.C.
Entity Type:Organization
Organization Name:LIFESPAN BEHAVIORAL HEALTH P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:HARINGS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:773-930-9553
Mailing Address - Street 1:1500 N HALSTED ST FL 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60642-2517
Mailing Address - Country:US
Mailing Address - Phone:773-930-9553
Mailing Address - Fax:
Practice Address - Street 1:1500 N HALSTED ST FL 2
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642-2517
Practice Address - Country:US
Practice Address - Phone:773-930-9553
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-16
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health