Provider Demographics
NPI:1598041048
Name:CENTER FOR CHANGE - LAWRENCE LLC
Entity Type:Organization
Organization Name:CENTER FOR CHANGE - LAWRENCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR/AUTHORIZED OFFCIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:F
Authorized Official - Last Name:LAKIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:316-640-0601
Mailing Address - Street 1:933 N TOPEKA ST
Mailing Address - Street 2:
Mailing Address - City:WITCHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214-3620
Mailing Address - Country:US
Mailing Address - Phone:316-201-1234
Mailing Address - Fax:316-201-1673
Practice Address - Street 1:1910 HASKELL AVE A-9
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66046-3246
Practice Address - Country:US
Practice Address - Phone:316-201-1234
Practice Address - Fax:316-201-1673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-28
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty