Provider Demographics
NPI:1225613557
Name:LIFETIME PSYCHIATRY LLC
Entity Type:Organization
Organization Name:LIFETIME PSYCHIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KARRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:COPELAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-477-6464
Mailing Address - Street 1:5700 MEXICO RD STE 8
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-1667
Mailing Address - Country:US
Mailing Address - Phone:636-477-6464
Mailing Address - Fax:636-410-9291
Practice Address - Street 1:5700 MEXICO RD STE 8
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-1667
Practice Address - Country:US
Practice Address - Phone:636-477-6464
Practice Address - Fax:636-410-9291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-17
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty