Provider Demographics
NPI:1437924123
Name:LIFE CONNECTIONS AUTISM SERVICES
Entity Type:Organization
Organization Name:LIFE CONNECTIONS AUTISM SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:DEFALCO GIBBS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-MHSP
Authorized Official - Phone:865-323-3870
Mailing Address - Street 1:408 N CEDAR BLUFF RD STE 252
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-3641
Mailing Address - Country:US
Mailing Address - Phone:865-323-3870
Mailing Address - Fax:865-888-5819
Practice Address - Street 1:408 N CEDAR BLUFF RD STE 252
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-3641
Practice Address - Country:US
Practice Address - Phone:865-323-3870
Practice Address - Fax:865-888-5819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-22
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty