| Lifesource Therapy Llc | |
|
8180 Sw Crater Loop Rd Terrebonne OR 97760-9004 | |
| (541) 777-7230 | |
| Not Available |
| Full Name | Lifesource Therapy Llc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 8180 Sw Crater Loop Rd, Terrebonne, Oregon |
| Authorized Official Name and Position | Gina R Lawrence (PROVIDER) |
| Authorized Official Contact | 5417777230 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lifesource Therapy Llc 1900 Ne 3rd St Ste 106 Bend OR 97701-3889 Ph: (541) 777-7230 | Lifesource Therapy Llc 8180 Sw Crater Loop Rd Terrebonne OR 97760-9004 Ph: (541) 777-7230 |
| NPI Number | 1003660036 |
|---|---|
| Provider Enumeration Date | 04/16/2024 |
| Last Update Date | 04/16/2024 |
| Certification Date | 04/16/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003660036 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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