Provider Demographics
NPI:1679374482
Name:LIFE PSYCHIATRY LLC
Entity type:Organization
Organization Name:LIFE PSYCHIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:HUSTED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-266-2084
Mailing Address - Street 1:1205 MERLOT DR
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-1529
Mailing Address - Country:US
Mailing Address - Phone:704-266-2084
Mailing Address - Fax:252-422-9274
Practice Address - Street 1:7501 BARFIELD LN
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:NC
Practice Address - Zip Code:28037-6403
Practice Address - Country:US
Practice Address - Phone:704-266-2084
Practice Address - Fax:252-422-9274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-19
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty