Provider Demographics
NPI:1689147621
Name:THE CENTER FOR LIFE CHANGES
Entity Type:Organization
Organization Name:THE CENTER FOR LIFE CHANGES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:BABANI
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:505-492-7252
Mailing Address - Street 1:3321B CANDELARIA RD NE STE 310
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-1908
Mailing Address - Country:US
Mailing Address - Phone:505-792-7252
Mailing Address - Fax:505-554-3435
Practice Address - Street 1:3321B CANDELARIA RD NE STE 310
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-1908
Practice Address - Country:US
Practice Address - Phone:505-482-7252
Practice Address - Fax:505-554-3435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-02
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM29502047Medicaid