| Center For Life Change | |
|
1317 15th St Se Demotte IN 46310-9393 | |
| (219) 987-3719 | |
| (219) 987-7729 |
| Full Name | Center For Life Change |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1317 15th St Se, Demotte, Indiana |
| Authorized Official Name and Position | Lori Eileen Groves (MARRIAGE AND FAMILY THERAPIST) |
| Authorized Official Contact | 2198667869 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Center For Life Change 1103 East Grace Street Building 2 Rensselaer IN 47978 Ph: (219) 866-7869 | Center For Life Change 1317 15th St Se Demotte IN 46310-9393 Ph: (219) 987-3719 |
| NPI Number | 1952681504 |
|---|---|
| Provider Enumeration Date | 08/26/2011 |
| Last Update Date | 04/24/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952681504 | NPI | - | NPPES |
| 201049690A | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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