Provider Demographics
NPI:1801146360
Name:CHANGING LIVES COUNSELING SERVICES, LLC
Entity type:Organization
Organization Name:CHANGING LIVES COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ AGENT
Authorized Official - Prefix:
Authorized Official - First Name:ADELMA
Authorized Official - Middle Name:R
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:813-416-6841
Mailing Address - Street 1:3000 GULF TO BAY BLVD
Mailing Address - Street 2:STE 210
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33759-4321
Mailing Address - Country:US
Mailing Address - Phone:813-416-6841
Mailing Address - Fax:
Practice Address - Street 1:3000 GULF TO BAY BLVD
Practice Address - Street 2:STE 210
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33759-4321
Practice Address - Country:US
Practice Address - Phone:813-416-6841
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-12
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH9542101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty