Organization
LIFESTREAM THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT SCOTT GMINDER (OWNER)
(951) 448-7035
Entity
Organization
Contact information
Practice address
10162 E OLLA AVE, MESA, AZ 85212-2378
(951) 448-7035
Mailing address
23520 MARBLEHEAD CIR, CANYON LAKE, CA 92587-7706
(951) 448-7035
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
09/20/2023
Last updated
09/20/2023
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