Provider Demographics
NPI:1366725061
Name:LIFE CHANGES HOLISTIC PSYCHOTHERAPYLLC
Entity type:Organization
Organization Name:LIFE CHANGES HOLISTIC PSYCHOTHERAPYLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BRISSENDEN
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:727-669-3911
Mailing Address - Street 1:2329 SUNSET POINT RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33765-1455
Mailing Address - Country:US
Mailing Address - Phone:727-699-3911
Mailing Address - Fax:727-669-3813
Practice Address - Street 1:2329 SUNSET POINT RD
Practice Address - Street 2:SUITE 203
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-1455
Practice Address - Country:US
Practice Address - Phone:727-699-3911
Practice Address - Fax:727-669-3813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-20
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH9249101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMH9249OtherLICENSE NUMBER