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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