Provider Demographics
NPI:1710641543
Name:LIFETREE BEHAVIORAL HEALTH, LLC
Entity Type:Organization
Organization Name:LIFETREE BEHAVIORAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:PELLEGRINO
Authorized Official - Suffix:
Authorized Official - Credentials:LBA, BCBA-D
Authorized Official - Phone:213-864-1870
Mailing Address - Street 1:417 FOREST ST STE 467
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49001-2747
Mailing Address - Country:US
Mailing Address - Phone:213-864-1870
Mailing Address - Fax:
Practice Address - Street 1:417 FOREST ST STE 467
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49001-2747
Practice Address - Country:US
Practice Address - Phone:213-864-1870
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-27
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health