Healthcare Provider Details

I. General information

NPI: 1720943822
Provider Name (Legal Business Name): CHANGES WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2025
Last Update Date: 12/20/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17100 LABRADOR ST
NORTHRIDGE CA
91325-1900
US

IV. Provider business mailing address

17100 LABRADOR ST
NORTHRIDGE CA
91325-1900
US

V. Phone/Fax

Practice location:
  • Phone: 832-215-5510
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: DR. LISA LIPTON
Title or Position: PROGRAM ADMINISTATOR
Credential: PSYD
Phone: 832-215-5510