Provider Demographics
NPI:1255577359
Name:LIFESPAN COUNSELING AND PSYCHOLOGICAL SERVICES, LLP
Entity type:Organization
Organization Name:LIFESPAN COUNSELING AND PSYCHOLOGICAL SERVICES, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ORSON
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRISON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:312-307-6554
Mailing Address - Street 1:6645 NORTH AVE
Mailing Address - Street 2:UPPER LEVEL
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-1057
Mailing Address - Country:US
Mailing Address - Phone:708-386-5080
Mailing Address - Fax:708-386-5099
Practice Address - Street 1:6645 NORTH AVE
Practice Address - Street 2:UPPER LEVEL
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-1057
Practice Address - Country:US
Practice Address - Phone:708-386-5080
Practice Address - Fax:708-386-5099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-20
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071006882103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty