Provider Demographics
NPI:1386060515
Name:CENTER FOR LIFE CHANGE, INC
Entity type:Organization
Organization Name:CENTER FOR LIFE CHANGE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:PLATTNER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:720-748-8113
Mailing Address - Street 1:950 WADSWORTH BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80214-4591
Mailing Address - Country:US
Mailing Address - Phone:720-748-8113
Mailing Address - Fax:303-954-0083
Practice Address - Street 1:950 WADSWORTH BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80214-4591
Practice Address - Country:US
Practice Address - Phone:720-748-8113
Practice Address - Fax:303-954-0083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-12
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSW99180971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCSW00991807OtherLICENSE
COCSW00991807OtherLICENSE