Provider Demographics
NPI:1336464940
Name:LIFE CHANGING MENTAL HEALTH, LLC.
Entity Type:Organization
Organization Name:LIFE CHANGING MENTAL HEALTH, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACTIVITY DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LOIS
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-635-1668
Mailing Address - Street 1:3937 PINES RD. SUITE H
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71119-7301
Mailing Address - Country:US
Mailing Address - Phone:318-635-1668
Mailing Address - Fax:
Practice Address - Street 1:3937 PINES RD. SUITE H
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71119-7301
Practice Address - Country:US
Practice Address - Phone:318-635-1668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-07
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health