MEDICARE: LIFE CHANGES WELLNESS COUNSELING

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	:	1972312411
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFE CHANGES WELLNESS COUNSELING

Provider Business Mailing Address
First Line	:	705 S MUSTANG RD STE 211
Second Line	:
City	:	YUKON
State	:	OK
Zip	:	73099-6778
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 ROBERT S KERR AVE STE 901A
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73102-4204
Country	:	US
Telephone Number	:	405-407-7776
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MICHELLE WINSTON
Credential	:
Telephone Number	:	405-312-6826

Provider Enumeration Date	:	12/30/2024
Last Update Date	:	06/03/2026

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Directions to “LIFE CHANGES WELLNESS COUNSELING ” Practice Location

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