Provider Demographics
NPI:1306185632
Name:LIFE CHANGE SOLUTIONS, INC.
Entity Type:Organization
Organization Name:LIFE CHANGE SOLUTIONS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:C
Authorized Official - Last Name:DODD
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC CADC
Authorized Official - Phone:641-420-6959
Mailing Address - Street 1:PO BOX 912
Mailing Address - Street 2:
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50402-0912
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:103 E STATE ST
Practice Address - Street 2:STE 301
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-3300
Practice Address - Country:US
Practice Address - Phone:641-201-1521
Practice Address - Fax:641-201-1521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-06
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00293251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health