| The Life Change Center | |
|
130 Vine St Reno NV 89503-5546 | |
| (775) 499-5534 | |
| (775) 355-7759 |
| Full Name | The Life Change Center |
|---|---|
| Speciality | Psychologist |
| Location | 130 Vine St, Reno, Nevada |
| Authorized Official Name and Position | Ryan Zeller (MEDICAL DIRECTOR) |
| Authorized Official Contact | 7753557734 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| The Life Change Center 1755 Sullivan Ln Sparks NV 89431-2815 Ph: (775) 355-7734 | The Life Change Center 130 Vine St Reno NV 89503-5546 Ph: (775) 499-5534 |
| NPI Number | 1922056415 |
|---|---|
| Provider Enumeration Date | 05/05/2006 |
| Last Update Date | 06/17/2024 |
| Certification Date | 06/17/2024 |
| Medicare PECOS PAC ID | 4183620602 |
|---|---|
| Medicare Enrollment ID | O20061005000586 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922056415 | NPI | - | NPPES |
| 001716006 | Medicaid | NV |
| Provider Name | Ryan P Zeller |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1346372760 PECOS PAC ID: 9537251160 Enrollment ID: I20070827000680 |
| Provider Name | Rahne L Girard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194200766 PECOS PAC ID: 1052644531 Enrollment ID: I20190620000559 |
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