Provider Demographics
NPI:1346966272
Name:LYFE SKILLS COLLABORATION
Entity Type:Organization
Organization Name:LYFE SKILLS COLLABORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROCHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-547-6293
Mailing Address - Street 1:801 PRAIRIE ST
Mailing Address - Street 2:
Mailing Address - City:WINNSBORO
Mailing Address - State:LA
Mailing Address - Zip Code:71295-2631
Mailing Address - Country:US
Mailing Address - Phone:318-367-5099
Mailing Address - Fax:318-367-5090
Practice Address - Street 1:801 PRAIRIE ST
Practice Address - Street 2:
Practice Address - City:WINNSBORO
Practice Address - State:LA
Practice Address - Zip Code:71295-2631
Practice Address - Country:US
Practice Address - Phone:318-367-5099
Practice Address - Fax:318-367-5090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-12
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health