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Organization

LIFECHANGE PSYCHOLOGICAL SERVICES, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. CHUCK EDGINGTON PH.D. (OWNER)
(405) 315-5756
Entity
Organization

Contact information

Practice address
4117 NW 122ND ST STE A1, OKLAHOMA CITY, OK 73120-8819
(405) 562-9260
(405) 260-9559
Mailing address
3612 LEA CT, EDMOND, OK 73013-8127

Taxonomy

Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
1088
OK

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
200254090A
OK
Enumeration date
08/10/2017
Last updated
01/23/2021
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