Provider Demographics
NPI:1508317504
Name:LIFE GROUP PSYCHOTHERAPY, INC
Entity Type:Organization
Organization Name:LIFE GROUP PSYCHOTHERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DILLON
Authorized Official - Middle Name:
Authorized Official - Last Name:STEINMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-236-0854
Mailing Address - Street 1:500 S AUSTRALIAN AVE
Mailing Address - Street 2:SUITE 639
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-6223
Mailing Address - Country:US
Mailing Address - Phone:561-236-0854
Mailing Address - Fax:419-851-9191
Practice Address - Street 1:500 S AUSTRALIAN AVE
Practice Address - Street 2:SUITE 639
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-6223
Practice Address - Country:US
Practice Address - Phone:561-236-0854
Practice Address - Fax:419-851-9191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-14
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty