# LIFE CHANGES MENTAL HEALTH SERVICES PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1659939536
- **Authorized official:** ELIZABETH L VON BARGEN NP (NURSE PRACTITIONER, OWNER)
- **Authorized official phone:** (208) 791-6183

## Contact information

- **Practice address:** 816 MAIN STREET, LEWISTON, ID 83501-1870
- **Practice address phone:** (208) 791-6183
- **Practice address fax:** (949) 404-8139
- **Mailing address:** PO BOX 472, CRAIGMONT, ID 83523-0472
- **Mailing address phone:** (208) 791-6183
- **Mailing address fax:** (949) 404-8139

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 06/05/2019
- **Last updated:** 04/07/2023