| Life Change Institute, Llc | |
|
8023 Royal Birkdale Circle Lakewood Ranch FL 34202-2538 | |
| (941) 400-9556 | |
| Not Available |
| Full Name | Life Change Institute, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 8023 Royal Birkdale Circle, Lakewood Ranch, Florida |
| Authorized Official Name and Position | Michael Leblond (CEO) |
| Authorized Official Contact | 9414009556 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Life Change Institute, Llc 8023 Royal Birkdale Circle Lakewood Ranch FL 34202-2538 Ph: (941) 400-9556 | Life Change Institute, Llc 8023 Royal Birkdale Circle Lakewood Ranch FL 34202-2538 Ph: (941) 400-9556 |
| NPI Number | 1548014970 |
|---|---|
| Provider Enumeration Date | 04/12/2024 |
| Last Update Date | 04/12/2024 |
| Certification Date | 04/12/2024 |
| Medicare PECOS PAC ID | 0547703688 |
|---|---|
| Medicare Enrollment ID | O20240618002044 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548014970 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| Provider Name | Michael H Leblond |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1063710952 PECOS PAC ID: 0749422574 Enrollment ID: I20170425001879 |
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