Organization
PSYCHOLOGY SPECIALISTS LTD
Active
Other names
LifeStance Health
Organization subpart
No
Provider details
NPI number
Authorized official
ADAM RUSSO (VP OF OPERATIONS)
(888) 428-7890
Entity
Organization
Contact information
Practice address
808 S ELDORADO RD STE 102, BLOOMINGTON, IL 61704-6075
(888) 428-7890
Mailing address
808 S ELDORADO RD STE 102, BLOOMINGTON, IL 61704-6075
(888) 428-7890
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
180-005332
IL
101Y00000X
Counselor
180-005747
IL
103TC0700X
Clinical Psychologist
071-005708
IL
103TC0700X
Clinical Psychologist
Primary
071-006198
IL
103TC0700X
Clinical Psychologist
071-006980
IL
1041C0700X
Clinical Social Worker
149011166
IL
Other
Enumeration date
05/28/2006
Last updated
09/26/2022
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