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Organization

LIFESPAN BEHAVIORAL HEALTH PLLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
JUSTIN R PERSOON (PRINCIPAL)
(231) 233-6576
Entity
Organization

Contact information

Practice address
1686 N LAKESHORE DR, LUDINGTON, MI 49431-9403
(231) 233-6576
(231) 845-7095
Mailing address
1686 N LAKESHORE DR, LUDINGTON, MI 49431-9403
(231) 233-6576
(231) 845-7095

Taxonomy

Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
640-101-3191
MI
103K00000X
Behavior Analyst
Primary
1-16-22081
MI
103TB0200X
Cognitive & Behavioral Psychologist
630-101-5191
MI

Other

Enumeration date
01/09/2017
Last updated
01/09/2017
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