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LIFECHANGE PSYCHOLOGICAL SERVICES, LLC

Clinical Neuropsychologist

Oklahoma City, Oklahoma

Provider NPI: 1295250207

Organization Information:
Organization Name:  LIFECHANGE PSYCHOLOGICAL SERVICES, LLC
Organization is not Subpart
Authorized Official:  CHUCK  EDGINGTON  OWNER  405-3155756

Practice Location:
4117 NW 122ND ST STE A1  OKLAHOMA CITY, OK 73120 US
Tel: 405-562-9260  Fax: 405-260-9559

Business Mailing Address:
3612 LEA CT  EDMOND, OK 73013 US
Tel: --  Fax: --

Entity Type: Organization

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
Y103G00000XBehavioral Health & Social Service Providers
Clinical Neuropsychologist
OK1088

Other Provider Identifiers:

IssuerNumberStateType
200254090AOK05
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin







CLINICAL NEUROPSYCHOLOGIST JOBS OK - Page 1



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