Organization
INSTITUTE FOR LIFE RENOVATION, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LORI EICKLEBERRY PH.D., ABPP (MANAGING PARTNER)
(954) 766-4955
Entity
Organization
Contact information
Practice address
1421 SE 4TH AVE, FORT LAUDERDALE, FL 33316-1940
(954) 766-4955
(954) 616-5147
Mailing address
1421 SE 4TH AVE FL 2, FORT LAUDERDALE, FL 33316-1900
(954) 766-4955
(954) 616-5147
Taxonomy
Speciality
Code
Description
License number
State
103TB0200X
Cognitive & Behavioral Psychologist
Primary
—
—
Other
Enumeration date
06/02/2017
Last updated
11/06/2023
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