| Life Support Therapy Services Llc | |
|
4035 Northpointe Dr Unit B Zanesville OH 43701-1738 | |
| (740) 487-1768 | |
| (740) 870-0086 |
| Full Name | Life Support Therapy Services Llc |
|---|---|
| Speciality | Counselor |
| Location | 4035 Northpointe Dr Unit B, Zanesville, Ohio |
| Authorized Official Name and Position | Jacquie Kirkbride (MANAGING PARTNER) |
| Authorized Official Contact | 7404871768 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Life Support Therapy Services Llc Po Box 2828 Zanesville OH 43702-2828 Ph: (740) 487-1768 | Life Support Therapy Services Llc 4035 Northpointe Dr Unit B Zanesville OH 43701-1738 Ph: (740) 487-1768 |
| NPI Number | 1194175497 |
|---|---|
| Provider Enumeration Date | 06/16/2016 |
| Last Update Date | 09/10/2024 |
| Certification Date | 09/10/2024 |
| Medicare PECOS PAC ID | 7618320565 |
|---|---|
| Medicare Enrollment ID | O20240127000356 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194175497 | NPI | - | NPPES |
| 1194175497 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Secondary |
| Provider Name | Alfred Kirkbride |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1639529936 PECOS PAC ID: 8527411479 Enrollment ID: I20240202002912 |
| Provider Name | Kamala Kae Tahyi |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1760925457 PECOS PAC ID: 4284075011 Enrollment ID: I20240510002721 |
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