Provider Demographics
NPI:1720263999
Name:LIFESPAN BEHAVIORAL HEALTH SERVICES,LLC
Entity Type:Organization
Organization Name:LIFESPAN BEHAVIORAL HEALTH SERVICES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:SCHEFFLER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:815-773-9503
Mailing Address - Street 1:21316 BROWN DR
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-9454
Mailing Address - Country:US
Mailing Address - Phone:815-773-9503
Mailing Address - Fax:815-469-4276
Practice Address - Street 1:21316 BROWN DR
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-9454
Practice Address - Country:US
Practice Address - Phone:815-773-9503
Practice Address - Fax:815-469-4276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-07
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL216028Medicare PIN
IL216032Medicare PIN
ILK48131Medicare PIN
ILK48187Medicare PIN