Provider Demographics
NPI:1578878757
Name:LIFE SUPPORT BEHAVIORAL INSTITUTE
Entity Type:Organization
Organization Name:LIFE SUPPORT BEHAVIORAL INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:DUNNING
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:888-516-5995
Mailing Address - Street 1:7853 E ARAPAHOE CT STE 3550
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-6827
Mailing Address - Country:US
Mailing Address - Phone:888-516-5995
Mailing Address - Fax:303-600-6629
Practice Address - Street 1:7853 E ARAPAHOE CT STE 3550
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-6827
Practice Address - Country:US
Practice Address - Phone:888-516-5995
Practice Address - Fax:303-600-6629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-12
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health