Provider Demographics
NPI:1952629198
Name:LIFEWORKS BEHAVIORAL HEALTH INC
Entity Type:Organization
Organization Name:LIFEWORKS BEHAVIORAL HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PERRY
Authorized Official - Middle Name:B
Authorized Official - Last Name:PRATT
Authorized Official - Suffix:
Authorized Official - Credentials:LPC/MHSP
Authorized Official - Phone:731-660-0199
Mailing Address - Street 1:174 MURRAY GUARD DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-3742
Mailing Address - Country:US
Mailing Address - Phone:731-660-0199
Mailing Address - Fax:731-660-3650
Practice Address - Street 1:174 MURRAY GUARD DR
Practice Address - Street 2:SUITE B
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-3742
Practice Address - Country:US
Practice Address - Phone:731-660-0199
Practice Address - Fax:731-660-3650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-12
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC813101YP2500X
TNLPC2718101YP2500X
TNAPRN11898364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental HealthGroup - Multi-Specialty