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General NPI Number Information
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NPI Number | 1770275729
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Entity Type | Organization
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Legal Business Name | LIFE CHANGING LLC
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Dates
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Enumeration Date | 05/25/2023
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Last Update Date | 05/25/2023
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Provider Practice Location Address
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Address Line | 917 W ADAMS AVE
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City | LAS VEGAS
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State | NV
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Zip | 89106-2916
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Country | US
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Telephone | 702-528-3240
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Fax |
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Provider Business Mailing Address
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Address Line | 917 W ADAMS AVE
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City | LAS VEGAS
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State | NV
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Zip | 89106-2916
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Country | US
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Telephone | 702-528-3240
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | DEIDRE JENKINS
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Credential | MS,MBA,LMFT
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Telephone | 702-562-1232
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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