Provider Demographics
NPI:1588824205
Name:LIFELINE MENTAL HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:LIFELINE MENTAL HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:CROLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-996-3682
Mailing Address - Street 1:313 RED FEATHER LN
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-4772
Mailing Address - Country:US
Mailing Address - Phone:888-996-3682
Mailing Address - Fax:888-996-3682
Practice Address - Street 1:313 RED FEATHER LN
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-4772
Practice Address - Country:US
Practice Address - Phone:888-996-3682
Practice Address - Fax:888-996-3682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty