Life Psychiatric Clinic PLLC

Primary specialty

Neurology PhysicianTaxonomy code 2084N0400X

Legal business name

LIFE PSYCHIATRIC CLINIC PLLC

Practice address

609 S Kelly Ave Ste B2
Edmond, OK 73003-5725

Phone

(405) 724-6871

Fax

(405) 726-0423

NPI assigned

Aug 4, 2021

Last updated

Apr 12, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mebin Babu Thomas, PA-CNPI 1598082737

Title

Member

Phone

(405) 414-9139

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OK

Enrollment records 1

Locations

Practitioners 4

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.

• Mebin Babu Thomas, PA-C

  • Medical Physician Assistant
  • Oklahoma City, OK
  • NPI 1598082737
  Medicare reassignment Care Compare group Authorized official
• Deziray Swing Click, P.A.-C

  • Physician Assistant
  • Edmond, OK
  • NPI 1578854931
  Medicare reassignment Care Compare group
• Paul F Lowe, PA-C

  • Physician Assistant
  • Oklahoma City, OK
  • NPI 1659697779
  Medicare reassignment Care Compare group
• Rakesh Amin, M.D.

  • Psychiatry Physician
  • Nashville, TN
  • NPI 1437445475

  OK

  Medicare reassignment NPD

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

{
    "created_epoch": "1628035200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649721600000",
    "number": "1427722370",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "609 S KELLY AVE STE B2",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "730035725",
            "telephone_number": "405-724-6871",
            "fax_number": "405-726-0423"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "609 S KELLY AVE STE B2",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "730035725",
            "telephone_number": "405-724-6871",
            "fax_number": "405-726-0423"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3501 French Park Dr Ste C",
            "address_purpose": "LOCATION",
            "city": "Edmond",
            "state": "OK",
            "postal_code": "730347290",
            "country_code": "US",
            "telephone_number": "405-724-6871",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LIFE PSYCHIATRIC CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-04",
        "last_updated": "2022-04-12",
        "certification_date": "2022-04-12",
        "status": "A",
        "authorized_official_last_name": "THOMAS",
        "authorized_official_first_name": "MEBIN",
        "authorized_official_middle_name": "BABU",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "405-414-9139",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201012720A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jennifer Si Li, MD
• Abigail Lichti
• Amy Lide
• Kathryn Ann Liem, COTA/L
• Shane Lietch
• Life Unexpected LLC
• Life Without Boundaries, LLC
• Lifecare Hospice, LLC
• Lifeline Mental Health Services, Inc
• Lighthouse Counseling and Assessment

• Neurology Physician in Edmond, OK
• Providers in Edmond, OK by specialty
• Neurology Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.