Provider Demographics
NPI:1710376967
Name:LIFE CHANGERS, INC
Entity Type:Organization
Organization Name:LIFE CHANGERS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CELESTE
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:MCGILL
Authorized Official - Suffix:
Authorized Official - Credentials:ED,D, LCSW,CADC
Authorized Official - Phone:773-531-9571
Mailing Address - Street 1:46 E 26TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-2304
Mailing Address - Country:US
Mailing Address - Phone:773-531-9571
Mailing Address - Fax:773-548-8093
Practice Address - Street 1:46 E 26TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-2304
Practice Address - Country:US
Practice Address - Phone:773-531-9571
Practice Address - Fax:773-548-8093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-12
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL15149101YA0400X
IL1490077581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty