Life Skills Institute Company Nathan's Place

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

34007000A Issued in IN

Legal business name

LIFE SKILLS INSTITUTE COMPANY NATHAN'S PLACE

Practice address

509 Millifiora LN
Kissimmee, FL 34759-4336

Phone

(219) 226-5567

Fax

(863) 496-5338

NPI assigned

Jul 21, 2016

Last updated

Apr 11, 2023By 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

Mrs. Doretha Michele McBride, LCSW, CADCNPI 1871928606

Title

Owner/Ceo/Therapist

Phone

(219) 226-5567

Specialties & licenses 1

Addresses

Practitioners 1

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.

• Doretha Michele McBride, LCSW, CADC

  • Clinical Social Worker
  • Kissimmee, FL
  • NPI 1871928606
  NPD Authorized official

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

{
    "created_epoch": "1469059200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1681171200000",
    "number": "1952754301",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "509 MILLIFIORA LN",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347594336",
            "telephone_number": "219-226-5567",
            "fax_number": "863-496-5338"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "509 MILLIFIORA LN",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347594336",
            "telephone_number": "219-226-5567",
            "fax_number": "863-496-5338"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE SKILLS INSTITUTE COMPANY NATHAN'S PLACE",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-21",
        "last_updated": "2023-04-11",
        "certification_date": "2023-04-11",
        "status": "A",
        "authorized_official_last_name": "MCBRIDE",
        "authorized_official_first_name": "DORETHA",
        "authorized_official_middle_name": "MICHELE",
        "authorized_official_title_or_position": "OWNER/CEO/THERAPIST",
        "authorized_official_telephone_number": "219-226-5567",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LCSW, CADC"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "IN",
            "license": "34007000A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Community/Behavioral Health Agency in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2023; 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.