Provider Demographics
NPI:1740725738
Name:LPS BEHAVIORAL HEALTH LLC
Entity type:Organization
Organization Name:LPS BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ROBISON
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:765-318-1225
Mailing Address - Street 1:3630 MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46151-9450
Mailing Address - Country:US
Mailing Address - Phone:765-318-1225
Mailing Address - Fax:800-596-3681
Practice Address - Street 1:3630 MEADOWS DR
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46151-9450
Practice Address - Country:US
Practice Address - Phone:765-318-1225
Practice Address - Fax:800-596-3681
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LPS BEHAVIORAL HEALTH LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-12-29
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20040289103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty