Provider Demographics
NPI:1558963397
Name:LIFESTREAM, INC
Entity Type:Organization
Organization Name:LIFESTREAM, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR DIRECTOR OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:
Authorized Official - Last Name:TUTTLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-993-1991
Mailing Address - Street 1:PO BOX 50487
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02745-0017
Mailing Address - Country:US
Mailing Address - Phone:508-993-1991
Mailing Address - Fax:508-985-9073
Practice Address - Street 1:1 FR DEVALLES BLVD
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02723-1511
Practice Address - Country:US
Practice Address - Phone:508-993-1991
Practice Address - Fax:508-674-2952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty