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LIFE CHANGE ASSOCIATES PC NPI 1598077562


NPI Information

NPI: 1598077562
Provider Name: LIFE CHANGE ASSOCIATES, PC
Classification: Psychiatry & Neurology - 2084P0800X
Entity Type: Organization

Specialization: Psychiatry

Address:
1777 E CLARK ST
SUITE 330
POCATELLO, ID
ZIP 83201
Phone: (208) 233-5433
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LIFE CHANGE ASSOCIATES, PC is a psychiatry psychiatry neurology in Pocatello, ID. The provider is a Psychiatrist specializes in the prevention, diagnosis, and treatment of mental disorders, emotional disorders, psychotic disorders, mood disorders, anxiety disorders, substance-related disorders, sexual and gender identity disorders and adjustment disorders. Biologic, psychological, and social components of illnesses are explored and understood in treatment of the whole person. Tools used may include diagnostic laboratory tests, prescribed medications, evaluation and treatment of psychological and interpersonal problems with individuals and families, and intervention for coping with stress, crises, and other problems. LIFE CHANGE ASSOCIATES, PC NPI is 1598077562. The provider is registered as an organization entity type and is a multiple single specialty group.

The provider's business location address is:

1777 E CLARK ST
SUITE 330
POCATELLO, ID
ZIP 83201-357
Phone: (208) 233-5433
Fax: (877) 284-2783

The provider's authorized official is Deric V Ravsten .
The authorized official title is Owner and has the following contact phone number (208) 233-5433.

The enumeration date for this NPI number is 7/7/2010 and was last updated on 11/23/2013.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1101YM0800XCounselorMental HealthIDAHONo
2363A00000XPhysician AssistantIDAHONo
32084P0800XPsychiatry & NeurologyPsychiatryIDAHOYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

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