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General NPI Number Information
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NPI Number | 1245601020
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Entity Type | Organization
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Legal Business Name | LIVING FOR A CHANGE LLC
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Dates
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Enumeration Date | 10/19/2015
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Last Update Date | 01/18/2017
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Provider Practice Location Address
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Address Line | 2045 LARAMIE AVE
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City | CASPER
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State | WY
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Zip | 82604
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Country | US
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Telephone | 850-274-7299
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Fax |
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Provider Business Mailing Address
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Address Line | 2045 LARAMIE AVE
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City | CASPER
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State | WY
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Zip | 82604
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Country | US
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Telephone | 850-274-7299
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Fax |
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Authorized Official
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Title or Position | LICENSED CLINICAL SOCIAL WORKER
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Name | LISA LYNNE LOVE
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Credential | LCSW
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Telephone | 850-274-7299
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 13189
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 1031
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License Number State | WY
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