Organization
LIFE CHANGE OUTPATIENT, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TARA MCBRIDE (PROGRAM ADMINISTRATOR)
(334) 498-5707
Entity
Organization
Contact information
Practice address
14400 BOGERT PKWY STE 600, OKLAHOMA CITY, OK 73134-2652
(405) 252-0823
Mailing address
14400 BOGERT PKWY STE 600, OKLAHOMA CITY, OK 73134-2652
(405) 252-0823
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Enumeration date
06/17/2026
Last updated
06/17/2026
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