Provider Demographics
NPI:1912335217
Name:LIFESTYLE CHANGES COUNSELING
Entity Type:Organization
Organization Name:LIFESTYLE CHANGES COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:L
Authorized Official - Last Name:VIRTUE
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:1208-734-5230
Mailing Address - Street 1:371 LOCUST ST S
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-7837
Mailing Address - Country:US
Mailing Address - Phone:208-734-5230
Mailing Address - Fax:
Practice Address - Street 1:371 LOCUST ST S
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-7837
Practice Address - Country:US
Practice Address - Phone:208-734-5230
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-23
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder