LIFESPARK PLLC (NPI# 1396217816) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1396217816 |
| Entity Type | Organization |
| Organization Name | LIFESPARK PLLC |
| Practice Address |
106 Public Sq Ste 105 Gallatin TN 37066 |
| Mailing Address |
106 Public Sq Ste 105 Gallatin TN 37066-3204 |
| Practice Telephone | 6156750025 |
| Practice Fax Number | 6156750026 |
| Mailing Telephone | 6156750025 |
| Mailing Fax Number | 6156750026 |
| Enumeration Date | 2018-12-21 |
| Last Update Date | 2019-09-09 |
| Authorized Official Name | DR. JASON HOLLAND (CEO) |
| Authorized Official Telephone | 4157028240 |
| Authorized Official Credential | PHD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 103TA0700X |
Psychologist Specialization: Adult Development & Aging |
Behavioral Health & Social Service Providers | ||
| N | 103TF0200X |
Psychologist Specialization: Forensic |
Behavioral Health & Social Service Providers | ||
| Y | 103TC0700X |
Psychologist Specialization: Clinical |
Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NPPES ORGANIZATIONAL NPI FOR MEANINGFUL LIVING LLC | 1407328214 | 01 | |
| NPPES INDIVIDUAL NPI | 1912478108 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 388 Albright Ln, Gallatin, TN 370668740 | 4157028240 |
| Street Address |
106 PUBLIC SQ STE 105 |
| City | GALLATIN |
| State | TN |
| Zip Code | 37066 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912478108 | Jason Holland | Psychologist | 106 Public Sq Ste 105, Gallatin, TN 37066 | 2018-12-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336748235 | Results-ast Jv, LLC | Physical Therapist | 110 St. Blaise Road, Suite 101, Gallatin, TN 37066 | 2020-10-21 |
| 1306445531 | Results-ast Jv, LLC | Physical Therapist | 132 North Belvedere Dr, Gallatin, TN 37066 | 2020-10-19 |
| 1063065969 | Tennessee Dental Professionals PC | Dentist | 2069 Nashville Pike, Gallatin, TN 37066 | 2019-07-19 |
| 1619463148 | Perkins Greenlea LLC | Pharmacy | 879 Greenlea Blvd, Suite 101, Gallatin, TN 37066 | 2018-07-09 |
| 1316432792 | Ann Elizabeth Willert | Counselor | 322 Sumner Hall Drive, Gallatin, TN 37066 | 2018-06-27 |
| 1255852661 | Samantha Jo Kelly | Dentist | 1710 Nashville Pike # 102, Gallatin, TN 37066 | 2017-07-06 |
| 1265880470 | Mallory Jane Hackbarth | Dentist | 923 Nashville Pike A, Gallatin, TN 37066 | 2016-05-27 |
| 1124493697 | Jennifer Stroud | Counselor | 273 Big Station Camp Blvd, 30-206, Gallatin, TN 37066 | 2015-12-09 |
| 1982075651 | Lacefield Enterprises, Inc | Speech-Language Pathologist | 1010 Broughton Place, Gallatin, TN 37066 | 2015-10-07 |
| 1073997532 | Anesthesia Partners of Gallatin, LLC | Nurse Anesthetist, Certified Registered | 890 North Blue Jay Way, Gallatin, TN 37066 | 2015-07-15 |
| Find all providers in zip 37066 | ||||
| Taxonomy Code | 103TC0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811597727 | Dorsey Matthew Howard | Psychologist | 315 33rd Ave N, Nashville, TN 37209-3941 | 2020-10-29 |
| 1003422874 | Daniel Diperna | Psychologist | 4205 Hillsboro Pike Ste 301, Nashville, TN 37215-3339 | 2020-09-17 |
| 1073137758 | Stephanie Nicole Zuckerman | Psychologist | Intrepid Street, Bldg. S-771, Millington, TN 38054 | 2020-05-29 |
| 1447873906 | Virtual Adhd Services and Testing | Psychologist | 8935 Magnolia Leaf Cv, Cordova, TN 38018-7413 | 2020-05-19 |
| 1538781679 | David R Richie | Psychologist | 680 Russell Rd, Bolivar, TN 38008-3573 | 2020-05-12 |
| 1710513890 | Elizabeth Katharine Collier Baker | Psychologist | 1800 Volunteer Blvd Fl 2, Knoxville, TN 37996-4522 | 2020-03-20 |
| 1881220697 | Rachel Miller Slough | Psychologist | 801 S Dossett Drive, Johnson City, TN 37614 | 2020-03-13 |
| 1164067518 | Jared Scott Yaw | Psychologist | 907 Maynor St, Nashville, TN 37216-3021 | 2019-11-08 |
| 1972144285 | Lauren Dattilo | Psychologist | 1211 21st Ave S Bldg Suite010, Nashville, TN 37212-2717 | 2019-10-08 |
| 1720635030 | Amy Rebekah Murrell | Psychologist | 8558 Ericson Cv, Cordova, TN 38018-7312 | 2019-08-21 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.