Life Source, Inc.

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

LIFE SOURCE, INC.

Practice address

2530 Douglas Blvd
Suite 160
Roseville, CA 95661-3989

Phone

(916) 784-0110

NPI assigned

Apr 2, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Orville E Easterly, MFT

Title

Clinical Director

Phone

(916) 784-0110

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1175472000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1619098332",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2530 DOUGLAS BLVD",
            "address_2": "SUITE 160",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "956613989",
            "telephone_number": "916-784-0110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2530 DOUGLAS BLVD",
            "address_2": "SUITE 160",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "956613989",
            "telephone_number": "916-784-0110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE SOURCE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-02",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "EASTERLY",
        "authorized_official_first_name": "ORVILLE",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "916-784-0110",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MFT"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jason Noel Li, DO
• Ziqian Li, MS, RDN, CDCES, CNSC
• Leanne M Liddicoat, O.D.
• Lien Lac LMFT
• Rebecca Lierly, M.A.
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• Don C Light, CADC II

• Mental Health Counselor in Roseville, CA
• Providers in Roseville, CA by specialty
• Mental Health Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.