Organization
LIFESTREAM BEHAVIORAL CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CAROL E DOZIER CPA (CFO)
(352) 315-7532
Entity
Organization
Contact information
Practice address
2020 TALLEY RD, LEESBURG, FL 34748-3426
(352) 315-7800
(352) 315-6595
Mailing address
PO BOX 491000, LEESBURG, FL 34749-1000
(352) 315-7500
(352) 360-6595
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
—
—
2084P0800X
Psychiatry Physician
—
—
251B00000X
Case Management Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
283Q00000X
Psychiatric Hospital
Primary
4075
FL
323P00000X
Psychiatric Residential Treatment Facility
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
024576301
—
FL
05
—
060334100
—
FL
05
—
060334102
—
FL
05
—
060334105
—
FL
05
—
060334108
—
FL
01
—
151443
WELLCARE PROVIDER #
FL
05
—
360181100
—
FL
01
—
98270
BCBS OUTPATIENT NUMBER
FL
01
—
E-83
BCBS INPATIENT NUMBER
FL
Enumeration date
06/23/2005
Last updated
07/18/2012
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