NPIMap

Organization Active NPI

Lifespan Behavioral Health, LLC

  • Clinical Psychologist
  • Mesa, AZ
National Provider Identifier
1033229281
Registry record updated Apr 23, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
3676 Issued in AZ
Legal business name
LIFESPAN BEHAVIORAL HEALTH, LLC
Practice address
1745 S Alma School Rd
172
Mesa, AZ 85210-3009
Phone
(602) 324-4676
Fax
(480) 209-1063
NPI assigned
Aug 30, 2006
Last updated
Apr 23, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ronald Colby Miller, PSY.D.NPI 1326158577
Title
Psychologist/Owner
Phone
(602) 622-3021

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X 3676 AZ Primary

Addresses

Primary practice location

1745 S Alma School Rd
172
Mesa, AZ 85210-3009

Mailing address

1745 S Alma School Rd
172
Mesa, AZ 85210-3009
Phone (602) 324-4676

Other identifiers 4

IdentifierTypeStateIssuer
944654MedicaidAZ
944654OtherAZMERCY CARE
372456OtherAZMHN
944654OtherAZEVERCARE

Other names 1

  • Individual and Family Psychological Services, LLC Former legal business name

National Provider Directory

National Provider Directory

Locations

1745 S Alma School Rd
Ste 172
Mesa, AZ 85210
Phone (602) 324-4676

4620 N 16th St
Ste E110
Phoenix, AZ 85016
Phone (602) 264-2770

3370 N Hayden Rd
Ste 123642
Scottsdale, AZ 85251
Phone (602) 324-4676

Practitioners & affiliated clinicians

Practitioners 21

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 21

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1240444800000",
    "number": "1033229281",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1745 S ALMA SCHOOL RD",
            "address_2": "172",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852103009",
            "telephone_number": "602-324-4676",
            "fax_number": "480-209-1063"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1745 S ALMA SCHOOL RD",
            "address_2": "172",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852103009",
            "telephone_number": "602-324-4676",
            "fax_number": "480-209-1063"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFESPAN BEHAVIORAL HEALTH, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-30",
        "last_updated": "2009-04-23",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "RONALD",
        "authorized_official_middle_name": "COLBY",
        "authorized_official_title_or_position": "PSYCHOLOGIST/OWNER",
        "authorized_official_telephone_number": "602-622-3021",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "AZ",
            "license": "3676",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "944654",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MERCY CARE",
            "identifier": "944654",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MHN",
            "identifier": "372456",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EVERCARE",
            "identifier": "944654",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Individual and Family Psychological Services, LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Mesa, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.