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Organization
LIFE CHANGE CORP
Active
Organization
LIFE CHANGE CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TLAHJONTE HOPSON (BOARD CHAIRMAN)
(602) 799-2757
Entity
Organization
Contact information
Practice address
2995 W FAIRMOUNT AVE, PHOENIX, AZ 85017-4614
(602) 799-2757
Mailing address
4513 W LODGE DR, LAVEEN, AZ 85339-7788
(602) 799-2757
(480) 525-7974
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
—
—
208100000X
Physical Medicine & Rehabilitation Physician
—
—
2084P0800X
Psychiatry Physician
—
—
208D00000X
General Practice Physician
—
—
251S00000X
Community/Behavioral Health Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
261QC1500X
Community Health Clinic/Center
—
—
261QH0100X
Health Service Clinic/Center
—
—
261QP2300X
Primary Care Clinic/Center
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
261QU0200X
Urgent Care Clinic/Center
Primary
—
—
Other
Enumeration date
01/16/2025
Last updated
01/06/2026
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