Provider Demographics
NPI:1407111503
Name:THE LIFE CENTER OF THE SUNCOAST, INC.
Entity Type:Organization
Organization Name:THE LIFE CENTER OF THE SUNCOAST, INC.
Other - Org Name:THE LIFE CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR & LICENSED COUNS
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERYLE
Authorized Official - Middle Name:R
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC 1340
Authorized Official - Phone:813-237-3114
Mailing Address - Street 1:6811 N. CENTRAL AVENUE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33604-5500
Mailing Address - Country:US
Mailing Address - Phone:813-237-3114
Mailing Address - Fax:866-457-5422
Practice Address - Street 1:6811 N. CENTRAL AVENUE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33604-5500
Practice Address - Country:US
Practice Address - Phone:813-237-3114
Practice Address - Fax:866-457-5422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-05
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLLMHC1340101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty