Provider Demographics
NPI:1407311616
Name:FULL OF LIFE THERAPY LLC
Entity Type:Organization
Organization Name:FULL OF LIFE THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LISW
Authorized Official - Prefix:
Authorized Official - First Name:EIESHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:REID-OVERBAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-729-7563
Mailing Address - Street 1:731 HUMOCK CT
Mailing Address - Street 2:
Mailing Address - City:MAINEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45039-7369
Mailing Address - Country:US
Mailing Address - Phone:817-729-7563
Mailing Address - Fax:
Practice Address - Street 1:11427 REED HARTMAN HWY
Practice Address - Street 2:
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45241-2418
Practice Address - Country:US
Practice Address - Phone:513-268-6055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-01
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health