Provider Demographics
NPI:1366503633
Name:LIFESPAN PSYCHOLOGICAL SERVICES, PS
Entity Type:Organization
Organization Name:LIFESPAN PSYCHOLOGICAL SERVICES, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CURTIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:206-780-7782
Mailing Address - Street 1:11290 SUNRISE DR NE
Mailing Address - Street 2:SUITE B
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-1353
Mailing Address - Country:US
Mailing Address - Phone:206-780-7782
Mailing Address - Fax:206-780-1964
Practice Address - Street 1:11290 SUNRISE DR NE
Practice Address - Street 2:SUITE B
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-1353
Practice Address - Country:US
Practice Address - Phone:206-780-7782
Practice Address - Fax:206-780-1964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00002203103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty