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LIFE360 COMMUNITY SERVICES NPI 1720751688


NPI Information

NPI: 1720751688
Provider Name: LIFE360 COMMUNITY SERVICES
Classification: Clinic/Center - 261QM0855X
Entity Type: Organization

Specialization: Adolescent and Children Mental Health

Address:
836 S SUBURBAN AVE
SPRINGFIELD, MO
ZIP 65802
Phone: (417) 658-5409
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LIFE360 COMMUNITY SERVICES is an adolescent and children mental health clinic center in Springfield, MO. The provider is an entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in children and adolescents. Services may be provided to parents and family members of the patient in the form of conjoint, group, or individual therapy, and education and/or training. LIFE360 COMMUNITY SERVICES NPI is 1720751688. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

836 S SUBURBAN AVE
SPRINGFIELD, MO
ZIP 65802-774
Phone: (417) 658-5409

The provider's authorized official is Gene Estrada Garcia .
The authorized official title is Counseling Services Director and has the following contact phone number (417) 658-5409.

The enumeration date for this NPI number is 7/27/2021 and was last updated on 3/1/2022.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1101YM0800XCounselorMental HealthNo
2261QM0850XClinic/CenterAdult Mental HealthNo
3261QM0855XClinic/CenterAdolescent and Children Mental HealthYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
11578916946MEDICAIDMISSOURI

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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