Life Change Associates, Pc

LBN: Life Change Associates, Pc
Life Change Associates, Pc is an health care organization with primary practice located at 1777 E Clark St Suite 330, Pocatello ID 83201-3357. The organization recently has 3 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Mental Health, Allopathic & Osteopathic Physicians / Psychiatry, Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant. Allopathic & Osteopathic Physicians / Psychiatry is the primary health care specialty. Life Change Associates, Pc can be contacted via phone (208) 233-5433, or through Ravsten, Deric V via phone (208) 233-5433.

Contact Information

Primary practice address
1777 E Clark St Suite 330 Pocatello ID 83201-3357
Phone: (208) 233-5433
Fax: (877) 284-2783
Website:
Map and Directions
Authorized official contact:
Name: Ravsten, Deric V Doctor of Osteopathy (DO)
Phone: (208) 233-5433

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Mental Health 101YM0800X Idaho
Allopathic & Osteopathic Physicians / Psychiatry 2084P0800X Idaho
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X Idaho

Profile Details

NPI number 1598077562
LBN Legal business name Life Change Associates, Pc
DBA Doing business as
Authorized official Ravsten, Deric V Doctor of Osteopathy (DO)
Entity Organization
Organization subpart 1 No
Enumeration date Jul 7th, 2010
Last updated Nov 23rd, 2013 - about 11 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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