Organization
MIDWEST BEHAVIORAL HEALTH LLC
Active
Other names
dba LifeStance Health
Organization subpart
No
Provider details
NPI number
Authorized official
RYAN PARDO (CHIEF LEGAL OFFICER)
(206) 399-1493
Entity
Organization
Contact information
Practice address
7300 E INDIANA ST, SUITE 103, EVANSVILLE, IN 47715-2794
(812) 401-8008
Mailing address
4800 N SCOTTSDALE RD STE 2500, SCOTTSDALE, AZ 85251-7630
(253) 346-0392
(602) 865-7811
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
20040842A
IN
104100000X
Social Worker
34000761A
IN
2084P0800X
Psychiatry Physician
Primary
02001874A
IN
Other
Enumeration date
08/04/2010
Last updated
04/05/2024
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