Healthcare Provider Details

I. General information

NPI: 1689147621
Provider Name (Legal Business Name): THE CENTER FOR LIFE CHANGES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2019
Last Update Date: 01/04/2024
Certification Date: 01/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3321B CANDELARIA RD NE STE 310
ALBUQUERQUE NM
87107-1908
US

IV. Provider business mailing address

3321B CANDELARIA RD NE STE 310
ALBUQUERQUE NM
87107-1908
US

V. Phone/Fax

Practice location:
  • Phone: 505-482-7252
  • Fax: 505-554-3435
Mailing address:
  • Phone: 505-792-7252
  • Fax: 505-554-3435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: DR. ALEX BABANI
Title or Position: OWNER/MEMBER
Credential: LPCC
Phone: 505-492-7252