Provider Demographics
NPI:1578147971
Name:LIFESTREAM BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:LIFESTREAM BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCILRATH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:023-798-7033
Mailing Address - Street 1:1201 PHILADELPHIA PIKE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19809-2042
Mailing Address - Country:US
Mailing Address - Phone:302-798-4400
Mailing Address - Fax:302-798-3002
Practice Address - Street 1:1201 PHILADELPHIA PIKE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19809-2042
Practice Address - Country:US
Practice Address - Phone:302-798-4400
Practice Address - Fax:302-798-3002
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIFESTREAM BEHAVIORAL HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-05-11
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty