Provider Demographics
NPI:1548014970
Name:LIFE CHANGE INSTITUTE, LLC
Entity type:Organization
Organization Name:LIFE CHANGE INSTITUTE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LEBLOND
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, MBA
Authorized Official - Phone:941-400-9556
Mailing Address - Street 1:8023 ROYAL BIRKDALE CIRCLE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34202-2538
Mailing Address - Country:US
Mailing Address - Phone:941-400-9556
Mailing Address - Fax:
Practice Address - Street 1:8023 ROYAL BIRKDALE CIRCLE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34202-2538
Practice Address - Country:US
Practice Address - Phone:941-400-9556
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-12
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health