Provider Demographics
NPI:1871183954
Name:LIFE CHANGES, LLC
Entity Type:Organization
Organization Name:LIFE CHANGES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC, NCC
Authorized Official - Phone:407-376-0991
Mailing Address - Street 1:9300 CONROY-WINDERMERE
Mailing Address - Street 2:#3341
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-9997
Mailing Address - Country:US
Mailing Address - Phone:407-376-0991
Mailing Address - Fax:321-234-8272
Practice Address - Street 1:255 PRIMERA BLVD
Practice Address - Street 2:SUITE 60
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-2168
Practice Address - Country:US
Practice Address - Phone:407-376-0991
Practice Address - Fax:321-234-8272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-22
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty