Provider Demographics
NPI:1164103594
Name:LIFEOAK MENTAL HEALTH PLLC
Entity Type:Organization
Organization Name:LIFEOAK MENTAL HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RUNAKO
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:214-693-5746
Mailing Address - Street 1:3707 E SOUTHERN AVE STE 1018
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-6201
Mailing Address - Country:US
Mailing Address - Phone:602-878-7702
Mailing Address - Fax:602-878-7702
Practice Address - Street 1:3707 E SOUTHERN AVE STE 1018
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-6201
Practice Address - Country:US
Practice Address - Phone:602-878-7702
Practice Address - Fax:602-878-7702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty