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General NPI Number Information
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NPI Number | 1700697976
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Entity Type | Organization
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Legal Business Name | LIFE CHANGE CORP
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Dates
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Enumeration Date | 01/16/2025
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Last Update Date | 01/06/2026
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Provider Practice Location Address
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Address Line | 2995 W FAIRMOUNT AVE
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City | PHOENIX
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State | AZ
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Zip | 85017-4614
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Country | US
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Telephone | 602-799-2757
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Fax |
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Provider Business Mailing Address
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Address Line | 4513 W LODGE DR
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City | LAVEEN
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State | AZ
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Zip | 85339-7788
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Country | US
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Telephone | 602-799-2757
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Fax | 480-525-7974
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Authorized Official
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Title or Position | BOARD CHAIRMAN
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Name | MRS. TLAHJONTE HOPSON
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Credential |
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Telephone | 602-799-2757
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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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 | 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 #3
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #10
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #11
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #12
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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