Provider Demographics
NPI:1700019585
Name:LIFE PATHS OF FLORIDA LLC
Entity Type:Organization
Organization Name:LIFE PATHS OF FLORIDA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JOYE
Authorized Official - Middle Name:D
Authorized Official - Last Name:HEAL
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:321-622-5250
Mailing Address - Street 1:1600 W EAU GALLIE BLVD
Mailing Address - Street 2:SUITE 201-H
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-4149
Mailing Address - Country:US
Mailing Address - Phone:321-622-5250
Mailing Address - Fax:321-622-5250
Practice Address - Street 1:1600 W EAU GALLIE BLVD
Practice Address - Street 2:SUITE 201-H
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-4149
Practice Address - Country:US
Practice Address - Phone:321-622-5250
Practice Address - Fax:321-622-5250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-27
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL764145100Medicaid
FLMH 9781OtherLMHC
FLMH 9197OtherLMHC