Provider Demographics
NPI:1679317127
Name:LIFESPAN PSYCHIATRIC SERVICES, LLC
Entity type:Organization
Organization Name:LIFESPAN PSYCHIATRIC SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIANNE
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:FOLSOM
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:850-999-2996
Mailing Address - Street 1:1618 MAHAN CENTER BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5476
Mailing Address - Country:US
Mailing Address - Phone:850-999-2996
Mailing Address - Fax:833-450-4861
Practice Address - Street 1:1618 MAHAN CENTER BLVD STE 103
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5476
Practice Address - Country:US
Practice Address - Phone:850-999-2996
Practice Address - Fax:833-450-4861
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIFESPAN PSYCHIATRIC SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-06-20
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty