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Organization
THE LIFE CHANGE CENTER
Active
Organization
THE LIFE CHANGE CENTER
Active
Other names
American Therapeutic Association
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RYAN ZELLER DO (MEDICAL DIRECTOR)
(775) 355-7734
Entity
Organization
Contact information
Practice address
130 VINE ST, RENO, NV 89503-5546
(775) 499-5534
(775) 355-7759
Mailing address
1755 SULLIVAN LN, SPARKS, NV 89431-2815
(775) 355-7734
(775) 355-7759
Taxonomy
Speciality
Code
Description
License number
State
103TA0400X
Addiction (Substance Use Disorder) Psychologist
Primary
138101
NV
261QM2800X
Methadone Clinic
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001716006
—
NV
Enumeration date
05/05/2006
Last updated
06/17/2024
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