Provider Demographics
NPI:1104190180
Name:LIFE SOLUTIONS PSYCHOLOGICAL SERVICES, P.A.
Entity Type:Organization
Organization Name:LIFE SOLUTIONS PSYCHOLOGICAL SERVICES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LATOYA
Authorized Official - Middle Name:E
Authorized Official - Last Name:SHAKES MALONE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:954-583-4568
Mailing Address - Street 1:4121 NW 5TH ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-2120
Mailing Address - Country:US
Mailing Address - Phone:954-583-4568
Mailing Address - Fax:
Practice Address - Street 1:4121 NW 5TH ST
Practice Address - Street 2:SUITE 207
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-2120
Practice Address - Country:US
Practice Address - Phone:954-583-4568
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-08
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7376103T00000X, 103TF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamilyGroup - Multi-Specialty