LIFESPAN PSYCHOLOGICAL SERVICES, PS – Clinical Psychologist, NPI 1366503633
Clinical Psychologist
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for LIFESPAN PSYCHOLOGICAL SERVICES, PS
11290 SUNRISE DR NE STE B
BAINBRIDGE ISLAND, WA 981101353
Phone: (206) 780-7782
Fax: (206) 780-1964
Type: Mailing
1990 E Lohman Ave
Las Cruces, NM 880013172
Phone: (206) 780-7782
Fax: (206) 780-1964
Type: Location
11290, Sunrise Drive Northeast, Rollingbay, Bainbridge Island, Kitsap County, Washington, 98110, United States
SUITE B
BAINBRIDGE ISLAND, WA 981101353
Phone: (206) 780-7782
Fax: (206) 780-1964
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
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Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2016-10-05
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2023-10-31 (955 days ago).
Enrollment records
1
Earliest due date
2023-10-31
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| O20161005002866 | O | Clinic/Group Practice | WA | 2023-10-31 |
What to do next
- Verify current status on the CMS Revalidation Lookup Tool immediately.
- Complete revalidation in PECOS or contact your Medicare Administrative Contractor (MAC).
- Overdue revalidation can lead to deactivation of Medicare billing privileges.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 98110)
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