Provider Demographics
NPI:1467295485
Name:LIFE PSYCHOLOGY LLC
Entity type:Organization
Organization Name:LIFE PSYCHOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLY
Authorized Official - Middle Name:
Authorized Official - Last Name:DEREMO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:937-815-7208
Mailing Address - Street 1:10552 SUCCESS LN STE E
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45458-3664
Mailing Address - Country:US
Mailing Address - Phone:937-815-7208
Mailing Address - Fax:855-251-5211
Practice Address - Street 1:10552 SUCCESS LN STE E
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45458-3664
Practice Address - Country:US
Practice Address - Phone:937-815-7208
Practice Address - Fax:855-251-5211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty