Organization
LIFESPAN BEHAVIORAL HEALTH, LLC
Active
Organization
LIFESPAN BEHAVIORAL HEALTH, LLC
Active
Other names
Individual and Family Psychological Services, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
RONALD COLBY MILLER PSY.D. (PSYCHOLOGIST/OWNER)
(602) 622-3021
Entity
Organization
Contact information
Practice address
1745 S ALMA SCHOOL RD, 172, MESA, AZ 85210-3009
(602) 324-4676
(480) 209-1063
Mailing address
1745 S ALMA SCHOOL RD, 172, MESA, AZ 85210-3009
(602) 324-4676
(480) 209-1063
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
3676
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
372456
MHN
AZ
01
—
944654
MERCY CARE
AZ
05
—
944654
—
AZ
Enumeration date
08/30/2006
Last updated
04/23/2009
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