Provider Demographics
NPI:1326559154
Name:CHANGE LIVES THROUGH EDUCATION LLC
Entity Type:Organization
Organization Name:CHANGE LIVES THROUGH EDUCATION LLC
Other - Org Name:LEARNINGRX BRAIN TRAINING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHERVELLE
Authorized Official - Middle Name:DEMETRIA
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-620-2150
Mailing Address - Street 1:7756 ANTIGUA CV
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-9154
Mailing Address - Country:US
Mailing Address - Phone:901-212-1950
Mailing Address - Fax:
Practice Address - Street 1:4680 MERCHANTS PARK CIR STE 214
Practice Address - Street 2:
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-9132
Practice Address - Country:US
Practice Address - Phone:901-620-2150
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-19
Last Update Date:2017-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Single Specialty
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitationGroup - Single Specialty
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Single Specialty