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General NPI Number Information
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NPI Number | 1801146360
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Entity Type | Organization
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Legal Business Name | CHANGING LIVES COUNSELING SERVICES, LLC
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Dates
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Enumeration Date | 09/12/2012
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Last Update Date | 09/12/2012
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Provider Practice Location Address
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Address Line | 3000 GULF TO BAY BLVD STE 210
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City | CLEARWATER
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State | FL
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Zip | 33759-4321
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Country | US
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Telephone | 813-416-6841
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Fax |
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Provider Business Mailing Address
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Address Line | 3000 GULF TO BAY BLVD STE 210
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City | CLEARWATER
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State | FL
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Zip | 33759-4321
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Country | US
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Telephone | 813-416-6841
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Fax |
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Authorized Official
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Title or Position | OWNER/ AGENT
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Name | ADELMA R REYES
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Credential | LMHC
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Telephone | 813-416-6841
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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 | MH9542
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License Number State | FL
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