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NPI Code Detail

MEDICARE: LIFE CHANGING LLC

MEDICARE: LIFE CHANGING LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251S00000XCommunity/Behavioral Health Agency

General Provider Information

NPI Number : 1770275729
Entity Type Code : Organization
Provider Name (Legal Business Name) : LIFE CHANGING LLC
Provider Business Mailing Address
First Line : 917 W ADAMS AVE
Second Line :
City : LAS VEGAS
State : NV
Zip : 89106-2916
Country : US
Telephone Number : 702-528-3240
Fax Number :
Provider Business Practice Location Address
First Line : 917 W ADAMS AVE
Second Line :
City : LAS VEGAS
State : NV
Zip : 89106-2916
Country : US
Telephone Number : 702-528-3240
Fax Number :
Authorized Official
Title or Position : THERAPIST
Name : DEIDRE JENKINS
Credential : MS,MBA,LMFT
Telephone Number : 702-562-1232
Provider Enumeration Date : 05/25/2023
Last Update Date : 05/25/2023

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Directions to “LIFE CHANGING LLC ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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