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General NPI Number Information
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NPI Number | 1245829787
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Entity Type | Organization
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Legal Business Name | LIFE CHANGES, LLC
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Dates
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Enumeration Date | 01/11/2021
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Last Update Date | 01/11/2021
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Provider Practice Location Address
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Address Line | 255 PRIMERA BLVD STE 160
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City | LAKE MARY
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State | FL
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Zip | 32746-2168
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Country | US
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Telephone | 407-376-0991
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Fax | 321-234-8272
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Provider Business Mailing Address
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Address Line | 9300 CONROY WINDERMERE RD # 3341
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City | WINDERMERE
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State | FL
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Zip | 34786-9997
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Country | US
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Telephone | 407-376-0991
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Fax | 321-234-8272
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | MS. KIMBERLEY LEE WALKER
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Credential | LMHC, NCC
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Telephone | 407-376-0991
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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