Provider Demographics
NPI:1902164213
Name:LIFE CYCLE PSYCHOLOGICAL SERVICES
Entity Type:Organization
Organization Name:LIFE CYCLE PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ELMER
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-307-0205
Mailing Address - Street 1:1107 HOUND DOG TRL
Mailing Address - Street 2:
Mailing Address - City:SAINT HELEN
Mailing Address - State:MI
Mailing Address - Zip Code:48656-9538
Mailing Address - Country:US
Mailing Address - Phone:989-307-0205
Mailing Address - Fax:989-632-3325
Practice Address - Street 1:1107 HOUND DOG TRL
Practice Address - Street 2:
Practice Address - City:SAINT HELEN
Practice Address - State:MI
Practice Address - Zip Code:48656-9538
Practice Address - Country:US
Practice Address - Phone:989-307-0205
Practice Address - Fax:989-632-3325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-25
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty