Provider Demographics
NPI:1184128571
Name:LEARNING INSTITUTE FOR FUNCTIONAL EDUCATION (L.I.F.E.)
Entity type:Organization
Organization Name:LEARNING INSTITUTE FOR FUNCTIONAL EDUCATION (L.I.F.E.)
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:TERRA
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:OEHLER
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:209-900-3722
Mailing Address - Street 1:1620 N CARPENTER RD STE C19
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95351-1156
Mailing Address - Country:US
Mailing Address - Phone:209-900-3722
Mailing Address - Fax:209-859-9005
Practice Address - Street 1:1620 N CARPENTER RD STE C19
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95351-1156
Practice Address - Country:US
Practice Address - Phone:209-900-3722
Practice Address - Fax:209-859-9005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-20
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
252Y00000X
CA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No252Y00000XAgenciesEarly Intervention Provider AgencyGroup - Single Specialty