| Change Of Life | |
|
411 Roosevelt St Indianola MS 38751-3141 | |
| (662) 635-9972 | |
| (662) 452-5066 |
| Full Name | Change Of Life |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 411 Roosevelt St, Indianola, Mississippi |
| Authorized Official Name and Position | Pamela Lorraine Randle (CEO) |
| Authorized Official Contact | 6622073645 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Change Of Life 411 Roosevelt St Indianola MS 38751-3141 Ph: (662) 635-0794 | Change Of Life 411 Roosevelt St Indianola MS 38751-3141 Ph: (662) 635-9972 |
| NPI Number | 1245199975 |
|---|---|
| Provider Enumeration Date | 01/19/2026 |
| Last Update Date | 01/19/2026 |
| Certification Date | 01/19/2026 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245199975 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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