Organization
LIFESTREAM BEHAVIORAL HEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM FULLER (CHIEF OPERATING OFFICER)
(603) 494-1458
Entity
Organization
Contact information
Practice address
1301 2ND AVE SW STE 315, LARGO, FL 33770-3120
(727) 820-1177
(727) 820-1060
Mailing address
1839 CENTRAL AVE, ST PETERSBURG, FL 33713-9089
(603) 494-1458
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Enumeration date
05/22/2025
Last updated
05/22/2025
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