LIFESOURCE THERAPY LLC
NPI 1003660036
Counselor - Mental Health in Bend, OR
About Lifesource Therapy Llc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
LIFESOURCE THERAPY LLC (NPI 1003660036) is a healthcare organization registered as a mental health in Bend, Oregon and active in the NPI registry since April 2024. The organization maintains a secondary practice location in Silsbee and lists Gina R Lawrence, Provider, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Names 1
Secondary Practice Location 1
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Lifesource Therapy Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
Medicare enrollment records show 1 clinician reassigns Medicare billing to Lifesource Therapy LLC, which bills Medicare for the services this clinician delivers.
Clinician (1)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Lifesource Therapy LLC's NPI number?
The NPI number for Lifesource Therapy LLC is 1003660036. It was assigned to this organization in the NPPES registry on April 16, 2024. The provider is also known as Gina Lawrence.
Where is Lifesource Therapy LLC located?
Lifesource Therapy LLC is located at 24455 Dodds Rd, Bend, OR 97701. The listed phone number is (541) 777-7230.
What is Lifesource Therapy LLC's specialty?
The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.
Is Lifesource Therapy LLC enrolled in Medicare?
Yes. Lifesource Therapy LLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Lifesource Therapy LLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Mental Health Counselor) reassigns their Medicare billing to Lifesource Therapy LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
When was this NPI record last updated?
The NPPES record for Lifesource Therapy LLC was last updated on August 18, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Lifesource Therapy Llc · NPI 1003660036
Mental Health organization in Bend, Oregon. Organization record, active in the CMS NPPES registry since April 16, 2024.
## Identity
- **NPI:** 1003660036 (Entity type: Organization)
- **Enumerated:** April 16, 2024
- **Primary specialty:** Counselor - Mental Health · taxonomy 101YM0800X
- **Also known as:** Gina Lawrence (Other Name)
- **Organization subpart:** No
- **Authorized official:** Gina Lawrence, PROVIDER
## Practice location
- **Address:** 24455 DODDS RD, Bend, OR 97701-9665
- **Phone:** (541) 777-7230
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 1 clinician (Mental Health Counselor) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** August 18, 2025
---
Source: [NPI Profile](https://npiprofile.com/npi/1003660036) · Data from the CMS NPPES public registry.