Organization
LIFELAB KIDS FOUNDATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAI REDDY DEPA (OWNER)
(248) 629-4600
Entity
Organization
Contact information
Practice address
3178 HILTON RD, FERNDALE, MI 48220-1059
(248) 629-4600
(248) 331-2744
Mailing address
3178 HILTON RD, FERNDALE, MI 48220-1059
(248) 629-4600
(248) 331-2744
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
103K00000X
Behavior Analyst
Primary
—
—
225XM0800X
Mental Health Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
MI17359
—
MI
Enumeration date
08/23/2018
Last updated
03/20/2024
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