LIFE DEVELOPMENT RESOURCES PA NPI 1902953169

NPI Information

  • NPI: 1902953169
  • Provider Name: LIFE DEVELOPMENT RESOURCES, PA
  • Classification: Community/Behavioral Health - 251S00000X
  • Entity Type: Organization
  • CLIA Number: 24D2178445
  • Address: 7580 160TH ST W
    LAKEVILLE, MN
    ZIP 55044
  • Phone: (952) 898-1133

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NPI Details

LIFE DEVELOPMENT RESOURCES, PA is a community behavioral health in Lakeville, MN. The provider is a private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, intellectual disabilities, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment. LIFE DEVELOPMENT RESOURCES, PA NPI is 1902953169. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

7580 160TH ST W
LAKEVILLE, MN
ZIP 55044-348
Phone: (952) 898-1133
Fax: (952) 435-6797

The provider's authorized official is Kim Tracy Ross .
The authorized official title is Program Manager and has the following contact phone number (952) 564-6337.

The CLIA number assigned to this NPI record is 24D2178445 - community clinic with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 1/3/2007 and was last updated on 1/18/2025.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1101YA0400XCounselorAddiction (Substance Use Disorder)No
2101YM0800XCounselorMental HealthNo
3101YP2500XCounselorProfessionalNo
4103TC0700XPsychologistClinicalNo
5103TC1900XPsychologistCounselingNo
6103TC2200XPsychologistClinical Child & AdolescentNo
7103TP2701XPsychologistGroup PsychotherapyNo
8104100000XSocial WorkerNo
91041C0700XSocial WorkerClinicalNo
10106H00000XMarriage & Family TherapistNo
11251S00000XCommunity/Behavioral HealthMINNESOTAYes
12261Q00000XClinic/CenterNo
13261QR0405XClinic/CenterRehabilitation, Substance Use DisorderNo
14363LP0808XNurse PractitionerPsychiatric/Mental HealthNo
15364SP0808XClinical Nurse SpecialistPsychiatric/Mental HealthNo

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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