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Organization
LIFE SOURCE, INC.
Active
Organization
LIFE SOURCE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ORVILLE E EASTERLY MFT (CLINICAL DIRECTOR)
(916) 784-0110
Entity
Organization
Contact information
Practice address
2530 DOUGLAS BLVD, SUITE 160, ROSEVILLE, CA 95661-3989
(916) 784-0110
Mailing address
2530 DOUGLAS BLVD, SUITE 160, ROSEVILLE, CA 95661-3989
(916) 784-0110
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
04/02/2007
Last updated
08/22/2020
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