| Life Change Therapy Llc | |
|
2222 W Grand River Ave Ste A Okemos MI 48864-1604 | |
| (906) 319-8725 | |
| Not Available |
| Full Name | Life Change Therapy Llc |
|---|---|
| Speciality | Counselor |
| Location | 2222 W Grand River Ave Ste A, Okemos, Michigan |
| Authorized Official Name and Position | Mary Beth Houpt (CREDENTIALING) |
| Authorized Official Contact | 5176769797 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Life Change Therapy Llc Po Box 10 Mason MI 48854-0010 Ph: () - | Life Change Therapy Llc 2222 W Grand River Ave Ste A Okemos MI 48864-1604 Ph: (906) 319-8725 |
| NPI Number | 1275338857 |
|---|---|
| Provider Enumeration Date | 02/17/2025 |
| Last Update Date | 03/03/2025 |
| Certification Date | 03/03/2025 |
| Medicare PECOS PAC ID | 8628590320 |
|---|---|
| Medicare Enrollment ID | O20250324000462 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275338857 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101Y00000X | Counselor | (* (Not Available)) | Primary |
| Provider Name | Brigid Eilleen Havens |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1902533805 PECOS PAC ID: 2062947898 Enrollment ID: I20241203000892 |
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