Lifeline Youth & Family Services, Inc.

Primary specialty

CounselorTaxonomy code 101Y00000X

Legal business name

LIFELINE YOUTH & FAMILY SERVICES, INC.

Practice address

27 Pequignot Drive
Pierceton, IN 46562-9075

Phone

(260) 745-3322

NPI assigned

Oct 16, 2007

Organization subpart

No

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

Authorized official

Name

Michael J. Martin

Title

Chief Financial Officer

Phone

(260) 745-3322

Specialties & licenses 2

Addresses

Other identifiers 2

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

{
    "created_epoch": "1192492800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1239321600000",
    "number": "1952590911",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 80487",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468980487",
            "telephone_number": "260-745-3322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27 PEQUIGNOT DRIVE",
            "city": "PIERCETON",
            "state": "IN",
            "postal_code": "465629075",
            "telephone_number": "260-745-3322"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFELINE YOUTH & FAMILY SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-16",
        "last_updated": "2009-04-10",
        "status": "A",
        "authorized_official_last_name": "MARTIN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "260-745-3322"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "347C00000X",
            "taxonomy_group": "",
            "desc": "Private Vehicle",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200847310",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200847300",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Counselor in Pierceton, IN
• Providers in Pierceton, IN by specialty
• Counselor in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 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.