Healthcare Provider Details

I. General information

NPI: 1851118780
Provider Name (Legal Business Name): LIFE CHANGING SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2024
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 N 19TH ST STE 14
MONROE LA
71201-4942
US

IV. Provider business mailing address

PO BOX 1792
SHREVEPORT LA
71166-1792
US

V. Phone/Fax

Practice location:
  • Phone: 318-213-0904
  • Fax:
Mailing address:
  • Phone: 318-213-0904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES EDWARD THROWER JR.
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: LCSW
Phone: 318-213-1395