Provider Demographics
NPI:1184348922
Name:LIFEPATH CENTER PLLC
Entity type:Organization
Organization Name:LIFEPATH CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JOCELYN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ALEIADIH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:512-078-2249
Mailing Address - Street 1:4334 YELLOW DOCK PT
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80911-3194
Mailing Address - Country:US
Mailing Address - Phone:719-201-7270
Mailing Address - Fax:
Practice Address - Street 1:3769 TIBBETTS ST STE A
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-2638
Practice Address - Country:US
Practice Address - Phone:951-405-8131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-26
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Single Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health