Provider Demographics
NPI:1114096385
Name:PSYCHIATRIC AND COUNSELING ASSOCIATES LLC
Entity Type:Organization
Organization Name:PSYCHIATRIC AND COUNSELING ASSOCIATES LLC
Other - Org Name:LIFESTANCE HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF LEGAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:PARDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-279-8500
Mailing Address - Street 1:25101 CHAGRIN BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5694
Mailing Address - Country:US
Mailing Address - Phone:253-346-0392
Mailing Address - Fax:216-456-8128
Practice Address - Street 1:8400 W 110TH ST.
Practice Address - Street 2:STE 100
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-2307
Practice Address - Country:US
Practice Address - Phone:913-327-7505
Practice Address - Fax:216-456-8128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084B0040XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBehavioral Neurology & NeuropsychiatryGroup - Multi-Specialty