NPIMap

Organization Active NPI

Lifespan Behavioral Health PLLC

  • Behavior Analyst
  • Ludington, MI
National Provider Identifier
1275079683
Registry record updated Jan 9, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior AnalystTaxonomy code 103K00000X
License
1-16-22081 Issued in MI
Legal business name
LIFESPAN BEHAVIORAL HEALTH PLLC
Practice address
1686 N Lakeshore Dr
Ludington, MI 49431-9403
Phone
(231) 233-6576
Fax
(231) 845-7095
NPI assigned
Jan 9, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2017

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

Authorized official

Name
Justin R PersoonNPI 1699024745
Title
Principal
Phone
(231) 233-6576

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 101YP2500X 640-101-3191 MI
Behavior AnalystGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 103K00000X 1-16-22081 MI Primary
Cognitive & Behavioral PsychologistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 103TB0200X 630-101-5191 MI

Addresses

Primary practice location

1686 N Lakeshore Dr
Ludington, MI 49431-9403

Mailing address

1686 N Lakeshore Dr
Ludington, MI 49431-9403
Phone (231) 233-6576

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1483920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1483920000000",
    "number": "1275079683",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1686 N LAKESHORE DR",
            "city": "LUDINGTON",
            "state": "MI",
            "postal_code": "494319403",
            "telephone_number": "231-233-6576",
            "fax_number": "231-845-7095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1686 N LAKESHORE DR",
            "city": "LUDINGTON",
            "state": "MI",
            "postal_code": "494319403",
            "telephone_number": "231-233-6576",
            "fax_number": "231-845-7095"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFESPAN BEHAVIORAL HEALTH PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-09",
        "last_updated": "2017-01-09",
        "status": "A",
        "authorized_official_last_name": "PERSOON",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRINCIPAL",
        "authorized_official_telephone_number": "231-233-6576"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "MI",
            "license": "640-101-3191",
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Behavior Analyst",
            "state": "MI",
            "license": "1-16-22081",
            "primary": true
        },
        {
            "code": "103TB0200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "MI",
            "license": "630-101-5191",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ludington, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2017; 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.