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General NPI Number Information
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NPI Number | 1487102331
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Entity Type | Organization
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Legal Business Name | LIFESTYLE CHANGES COUNSELING, INC
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Dates
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Enumeration Date | 09/20/2016
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Last Update Date | 09/20/2016
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Provider Practice Location Address
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Address Line | 219 GOODING ST N
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City | TWIN FALLS
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State | ID
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Zip | 83301-6178
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Country | US
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Telephone | 208-734-5230
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Fax | 208-732-5894
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Provider Business Mailing Address
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Address Line | 219 GOODING ST N
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City | TWIN FALLS
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State | ID
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Zip | 83301-6178
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Country | US
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Telephone | 208-734-5230
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Fax | 208-732-5894
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Authorized Official
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Title or Position | PRESIDENT
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Name | WILLIAM L VIRTUE
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Credential |
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Telephone | 208-316-5436
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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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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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