| Lifestream Behavioral Center Inc | |
|
2020 Talley Rd Leesburg FL 34748-3426 | |
| (352) 315-7800 | |
| (352) 315-6595 |
| Full Name | Lifestream Behavioral Center Inc |
|---|---|
| Speciality | Psychiatric Hospital |
| Location | 2020 Talley Rd, Leesburg, Florida |
| Authorized Official Name and Position | Carol E Dozier (CFO) |
| Authorized Official Contact | 3523157532 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lifestream Behavioral Center Inc Po Box 491000 Leesburg FL 34749-1000 Ph: (352) 315-7500 | Lifestream Behavioral Center Inc 2020 Talley Rd Leesburg FL 34748-3426 Ph: (352) 315-7800 |
| NPI Number | 1902802002 |
|---|---|
| Provider Enumeration Date | 06/23/2005 |
| Last Update Date | 07/18/2012 |
| Medicare PECOS PAC ID | 7012992720 |
|---|---|
| Medicare Enrollment ID | O20040618000512 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902802002 | NPI | - | NPPES |
| 060334100 | Medicaid | FL | |
| 151443 | Other | FL | WELLCARE PROVIDER # |
| 060334108 | Medicaid | FL | |
| 060334102 | Medicaid | FL | |
| 98270 | Other | FL | BCBS OUTPATIENT NUMBER |
| E-83 | Other | FL | BCBS INPATIENT NUMBER |
| 024576301 | Medicaid | FL | |
| 060334105 | Medicaid | FL | |
| 360181100 | Medicaid | FL |
| Provider Name | Carol Anne Couts |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1033198825 PECOS PAC ID: 6507898939 Enrollment ID: I20050908000310 |
| Provider Name | Edgar A Walker |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1396898177 PECOS PAC ID: 4880616853 Enrollment ID: I20081025000023 |
| Provider Name | Susan M Archacki-resnik |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821258484 PECOS PAC ID: 1456495241 Enrollment ID: I20100217000333 |
| Provider Name | Brad J Broyles |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1629033493 PECOS PAC ID: 1951580315 Enrollment ID: I20110201000286 |
| Provider Name | Praxides Mbakaya-chen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700168085 PECOS PAC ID: 4789856147 Enrollment ID: I20111006000286 |
| Provider Name | Thomas J Valente |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1467416511 PECOS PAC ID: 8022281377 Enrollment ID: I20111101000558 |
| Provider Name | David A Dada |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1558637363 PECOS PAC ID: 7911142567 Enrollment ID: I20130402000130 |
| Provider Name | Maryann F Busacca |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1881935989 PECOS PAC ID: 1759528482 Enrollment ID: I20130516000302 |
| Provider Name | Maryann E Simpson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1417032780 PECOS PAC ID: 3779717343 Enrollment ID: I20131015000527 |
| Provider Name | Miguel A Correa |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1710198239 PECOS PAC ID: 9234035148 Enrollment ID: I20150113000674 |
| Provider Name | Sherri A Ferguson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669711826 PECOS PAC ID: 3577889229 Enrollment ID: I20150224001409 |
| Provider Name | Richard B Wallace |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1457442477 PECOS PAC ID: 7810932126 Enrollment ID: I20150410002115 |
| Provider Name | Nancy E Shaw |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1902125685 PECOS PAC ID: 4587983770 Enrollment ID: I20150511001493 |
| Provider Name | Sarah L Yong |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1487918389 PECOS PAC ID: 9931343597 Enrollment ID: I20160215001006 |
| Provider Name | Amanda V Craig Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629436282 PECOS PAC ID: 3375841885 Enrollment ID: I20160418001114 |
| Provider Name | Patricia Rogers |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699861625 PECOS PAC ID: 1254398993 Enrollment ID: I20160428000297 |
| Provider Name | Abid B Darr |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1871940783 PECOS PAC ID: 8628362514 Enrollment ID: I20160816002180 |
| Provider Name | Scott G Berg |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1376090498 PECOS PAC ID: 9537448238 Enrollment ID: I20161121002552 |
| Provider Name | Nageley J Michel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093258642 PECOS PAC ID: 1355622671 Enrollment ID: I20161228002231 |
| Provider Name | Adriana Bentum-tilus |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801330519 PECOS PAC ID: 7012291198 Enrollment ID: I20170309001645 |
| Provider Name | Natasha Vernon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437490190 PECOS PAC ID: 2163708298 Enrollment ID: I20170404001103 |
| Provider Name | Barbara Gurgen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679927719 PECOS PAC ID: 0648545079 Enrollment ID: I20171010003378 |
| Provider Name | Julie M Conrad |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639698822 PECOS PAC ID: 3971860818 Enrollment ID: I20171130000964 |
| Provider Name | Yasmin Panjwani |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194266080 PECOS PAC ID: 2163781584 Enrollment ID: I20180110002688 |
| Provider Name | Chantal P Baptiste |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851867766 PECOS PAC ID: 7911231246 Enrollment ID: I20190620001163 |
| Provider Name | Sharon R Williamson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1396767638 PECOS PAC ID: 9739592759 Enrollment ID: I20210113000851 |
| Provider Name | Vicki Sattler |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1720674542 PECOS PAC ID: 9638582521 Enrollment ID: I20210114001111 |
| Provider Name | Cornelia E Crum |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063093151 PECOS PAC ID: 3476962804 Enrollment ID: I20210514000633 |
| Provider Name | Chrystal Shirley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639759764 PECOS PAC ID: 7214337013 Enrollment ID: I20210616001246 |
| Provider Name | Terri Ann Saunders |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447724711 PECOS PAC ID: 7517350234 Enrollment ID: I20220201002637 |
| Provider Name | Ann Marie A Burke |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801364377 PECOS PAC ID: 1759774698 Enrollment ID: I20220217000011 |
| Provider Name | Emma M Oteri |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073135091 PECOS PAC ID: 3476931940 Enrollment ID: I20220613001134 |
| Provider Name | Rose Thompson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245884360 PECOS PAC ID: 0446630230 Enrollment ID: I20220711003046 |
| Provider Name | Altagrace K Souverain |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1003533423 PECOS PAC ID: 0547630733 Enrollment ID: I20230104002033 |
| Provider Name | Susan Wambui Gray |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306070701 PECOS PAC ID: 3779955042 Enrollment ID: I20230214003315 |
Kenneth Henschel, Md Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 10123 Us Highway 441, Leesburg, FL 34788 Phone: 352-901-6288 | |
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Central Florida Psychological Consultants Inc Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 1114 W Dixie Ave, Leesburg, FL 34748 Phone: 352-365-2243 Fax: 352-365-2285 | |
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Unique Niche Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 33741 S Haines Creek Rd, Leesburg, FL 34788 Phone: 352-460-1803 | |
Joyful Haven Supportive Services Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 11101 Fountain Lake Blvd, Leesburg, FL 34788 Phone: 352-406-2829 |