Provider Demographics
NPI:1609412618
Name:CHANGED LIVES SUBSTANCE ABUSE TREATMENT
Entity Type:Organization
Organization Name:CHANGED LIVES SUBSTANCE ABUSE TREATMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:T
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC, LCADC
Authorized Official - Phone:859-368-4105
Mailing Address - Street 1:149 DEWEESE ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40507-1925
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:149 DEWEESE ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40507-1925
Practice Address - Country:US
Practice Address - Phone:859-368-4105
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-25
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY246158OtherLCADC
KY266252OtherLPCC