| Functional Lifestyle Systems Inc | |
|
1303 31st Ave Greeley CO 80634-6327 | |
| (970) 690-9592 | |
| (970) 353-7888 |
| Full Name | Functional Lifestyle Systems Inc |
|---|---|
| Speciality | Psychologist |
| Location | 1303 31st Ave, Greeley, Colorado |
| Authorized Official Name and Position | Lori Ann Perrin (PSYCHOLOGIST) |
| Authorized Official Contact | 9706909592 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Functional Lifestyle Systems Inc 1303 31st Ave Greeley CO 80634-6327 Ph: (970) 690-9592 | Functional Lifestyle Systems Inc 1303 31st Ave Greeley CO 80634-6327 Ph: (970) 690-9592 |
| NPI Number | 1649868233 |
|---|---|
| Provider Enumeration Date | 01/08/2021 |
| Last Update Date | 12/13/2023 |
| Certification Date | 12/13/2023 |
| Medicare PECOS PAC ID | 3274981717 |
|---|---|
| Medicare Enrollment ID | O20231122001444 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649868233 | NPI | - | NPPES |
| 60335378 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Lori A Perrin |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1730369067 PECOS PAC ID: 9032263454 Enrollment ID: I20090820000116 |
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