Provider Demographics
NPI:1952754301
Name:LIFE SKILLS INSTITUTE COMPANY NATHAN'S PLACE
Entity Type:Organization
Organization Name:LIFE SKILLS INSTITUTE COMPANY NATHAN'S PLACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO/THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:DORETHA
Authorized Official - Middle Name:MICHELE
Authorized Official - Last Name:MCBRIDE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, CADC
Authorized Official - Phone:219-226-5567
Mailing Address - Street 1:509 MILLIFIORA LN
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34759-4336
Mailing Address - Country:US
Mailing Address - Phone:219-226-5567
Mailing Address - Fax:863-496-5338
Practice Address - Street 1:509 MILLIFIORA LN
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34759-4336
Practice Address - Country:US
Practice Address - Phone:219-226-5567
Practice Address - Fax:863-496-5338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-21
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34007000A251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health