Provider Demographics
NPI:1992834030
Name:LIFETIME BEHAVIORAL SERVICES
Entity Type:Organization
Organization Name:LIFETIME BEHAVIORAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:L
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:256-883-7031
Mailing Address - Street 1:PO BOX 4008
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35815-4008
Mailing Address - Country:US
Mailing Address - Phone:256-883-7031
Mailing Address - Fax:256-883-7032
Practice Address - Street 1:165 WHITESPORT DR SW
Practice Address - Street 2:SUITE 1
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-6484
Practice Address - Country:US
Practice Address - Phone:256-883-7031
Practice Address - Fax:256-883-7032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty