Provider Demographics
NPI:1255096426
Name:LIFESPAN: A CENTER FOR FAMILY PSYCHOLOGICAL SERVICES INC.
Entity type:Organization
Organization Name:LIFESPAN: A CENTER FOR FAMILY PSYCHOLOGICAL SERVICES INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:EDMON
Authorized Official - Middle Name:
Authorized Official - Last Name:ARTINYAN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:805-852-5039
Mailing Address - Street 1:964 EL SEGUNDO DR
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91362-2201
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2801 TOWNSGATE RD STE 133
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91361-5834
Practice Address - Country:US
Practice Address - Phone:805-852-5039
Practice Address - Fax:818-279-0585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-03
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty