Healthcare Provider Details

I. General information

NPI: 1871192401
Provider Name (Legal Business Name): LIFE CHANGE THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2020
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 S WATER ST STE 230
HENDERSON NV
89015-7308
US

IV. Provider business mailing address

303 S WATER ST STE 230
HENDERSON NV
89015-7308
US

V. Phone/Fax

Practice location:
  • Phone: 725-244-7223
  • Fax: 725-215-9766
Mailing address:
  • Phone: 725-244-7223
  • Fax: 725-215-9766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DAVID MICHAEL ROGERS
Title or Position: CEO/CLINICAL DIRECTOR-PRACTITIONER
Credential: PHD, LCSW, LCADC
Phone: 725-244-7223