Organization
MIDWEST BEHAVIORAL HEALTH LLC
Active
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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