THE LIFE CHANGE CENTER NPI 1922056415

NPI Information

NPI: 1922056415
Provider Name: THE LIFE CHANGE CENTER
Classification: Psychologist - 103TA0400X
Specialization: Addiction (Substance Use Disorder)
Entity Type: Organization
Former Legal Business Name: AMERICAN THERAPEUTIC ASSOCIATION
CLIA Number: 29D2177537
Address: 130 VINE ST
RENO, NV
ZIP 89503
Phone: (775) 499-5534

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NPI Details

THE LIFE CHANGE CENTER is an addiction (substance use disorder) psychologist in Reno, NV. The provider is a psychologist with a proficiency that involves the application of psychological treatment of addiction stemming from the use of alcohol and other psychoactive substances (e.g., nicotine, marijuana, cocaine, heroin) or behavioral addictions (e.g., gambling) with the aim of cessation or reduction of use and/or the amelioration of emotional, behavioral, interpersonal and other problems arising from the addictive behavior. THE LIFE CHANGE CENTER NPI is 1922056415. The provider is registered as an organization entity type and is a single specialty group.
The provider Former Legal Business Name Is American Therapeutic Association.

The provider's business location address is:

130 VINE ST
RENO, NV
ZIP 89503-546
Phone: (775) 499-5534
Fax: (775) 355-7759

The provider's authorized official is Ryan Zeller .
The authorized official title is Medical Director and has the following contact phone number (775) 355-7734.

The CLIA number assigned to this NPI record is 29D2177537 - practitioner other with a certificate type of Certificate of Waiver.

The following top HCPCS codes were publicly reported for this provider under the Medicare program for the year 2016. The reported codes are based on the top codes for each available Medicare specialty, excluding evaluation and management codes.

Medication assisted treatment, methadone; weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing, if performed (provision of the services by a medicare-enrolled opioid treatm (HCPCS:G2067)

The enumeration date for this NPI number is 5/5/2006 and was last updated on 6/17/2024.

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 Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	103TA0400X	Psychologist	Addiction (Substance Use Disorder)	138101	NEVADA	Yes
2	261QM2800X	Clinic/Center	Methadone			No
3	261QR0405X	Clinic/Center	Rehabilitation, Substance Use Disorder			No

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	001716006	MEDICAID	NEVADA

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: 3/30/2025

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