Provider Demographics
NPI:1275812992
Name:LIFE CHANGES COUNSELING & CONSULTING, INC
Entity Type:Organization
Organization Name:LIFE CHANGES COUNSELING & CONSULTING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CARLTON
Authorized Official - Middle Name:D
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHC
Authorized Official - Phone:575-693-8230
Mailing Address - Street 1:2701 PUTNAM DR
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88101-9351
Mailing Address - Country:US
Mailing Address - Phone:575-693-8230
Mailing Address - Fax:
Practice Address - Street 1:2300 N MAIN ST STE 29
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-3575
Practice Address - Country:US
Practice Address - Phone:575-693-8230
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-11
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0106271251S00000X
NMI-06845251S00000X
NMM-07179251S00000X
NM0125231251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health