Provider Demographics
NPI:1366600942
Name:LIFE THERAPY SERVICES, INC.
Entity type:Organization
Organization Name:LIFE THERAPY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LEAD PSYCHOTHERAPIST/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ZOE
Authorized Official - Middle Name:MIRANDA
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:661-718-2694
Mailing Address - Street 1:3053 RANCHO VISTA BLVD
Mailing Address - Street 2:STE. H #114
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-4823
Mailing Address - Country:US
Mailing Address - Phone:661-718-2694
Mailing Address - Fax:
Practice Address - Street 1:3053 RANCHO VISTA BLVD
Practice Address - Street 2:STE. H #114
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-4823
Practice Address - Country:US
Practice Address - Phone:661-718-2694
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-30
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39636106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty