| Lifespark Pllc | |
|
106 Public Sq Ste 105 Gallatin TN 37066 | |
| (615) 675-0025 | |
| (615) 675-0026 |
| Full Name | Lifespark Pllc |
|---|---|
| Speciality | Psychologist |
| Location | 106 Public Sq Ste 105, Gallatin, Tennessee |
| Authorized Official Name and Position | Jason Holland (CEO) |
| Authorized Official Contact | 4157028240 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lifespark Pllc 106 Public Sq Ste 105 Gallatin TN 37066-3204 Ph: (615) 675-0025 | Lifespark Pllc 106 Public Sq Ste 105 Gallatin TN 37066 Ph: (615) 675-0025 |
| NPI Number | 1396217816 |
|---|---|
| Provider Enumeration Date | 12/21/2018 |
| Last Update Date | 09/09/2019 |
| Medicare PECOS PAC ID | 1254679285 |
|---|---|
| Medicare Enrollment ID | O20190215002208 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396217816 | NPI | - | NPPES |
| 1407328214 | Other | NPPES ORGANIZATIONAL NPI FOR MEANINGFUL LIVING LLC | |
| 1912478108 | Other | NPPES INDIVIDUAL NPI |
| Provider Name | Jason Holland |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1912478108 PECOS PAC ID: 2163760190 Enrollment ID: I20190215002395 |
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