Provider Demographics
NPI:1942287891
Name:FACILITATING LIFE CHANGES INC
Entity Type:Organization
Organization Name:FACILITATING LIFE CHANGES INC
Other - Org Name:DIANA L BJORGEN PHD
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BJORGEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:406-327-9697
Mailing Address - Street 1:PO BOX 1328
Mailing Address - Street 2:FLC INC OR CUSTOM MEDICAL BILLING
Mailing Address - City:FLORENCE
Mailing Address - State:MT
Mailing Address - Zip Code:59833
Mailing Address - Country:US
Mailing Address - Phone:406-273-7600
Mailing Address - Fax:406-273-7601
Practice Address - Street 1:301 W SPRUCE ST
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802
Practice Address - Country:US
Practice Address - Phone:406-327-9697
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-30
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT307103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00099519OtherPR MED
MT490348Medicaid