MEDICARE: CHANGING LIVES FAMILY SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1588382360
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHANGING LIVES FAMILY SERVICES, LLC

Provider Business Mailing Address
First Line	:	8433 N BLACK CANYON HWY STE 200
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85021-4859
Country	:	US
Telephone Number	:	602-402-4474
Fax Number	:

Provider Business Practice Location Address
First Line	:	8433 N BLACK CANYON HWY STE 200
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85021-4859
Country	:	US
Telephone Number	:	602-402-4474
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. ANTHONY J BRATKO
Credential	:	MSC, LPC, LISAC
Telephone Number	:	602-402-4474

Provider Enumeration Date	:	08/18/2022
Last Update Date	:	08/18/2022

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Directions to “CHANGING LIVES FAMILY SERVICES, LLC ” Practice Location

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