Provider Demographics
NPI:1396166526
Name:LIFE SPAN MENTAL HEALTH, PLLC
Entity type:Organization
Organization Name:LIFE SPAN MENTAL HEALTH, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN NORTON
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:832-723-3884
Mailing Address - Street 1:2424 W HOLCOMBE BLVD
Mailing Address - Street 2:204
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-1934
Mailing Address - Country:US
Mailing Address - Phone:713-521-5930
Mailing Address - Fax:713-521-5832
Practice Address - Street 1:2424 W HOLCOMBE BLVD
Practice Address - Street 2:204
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1934
Practice Address - Country:US
Practice Address - Phone:713-521-5930
Practice Address - Fax:713-521-5832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-13
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX776641251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health