Organization
LIFE CHANGE PSYCHOTHERAPY INSTITUTE, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS F. MCKENNA PHD (PRESIDENT)
(505) 271-5050
Entity
Organization
Contact information
Practice address
1200 EUBANK BLVD NE, ALBUQUERQUE, NM 87112-5314
(505) 271-5050
(505) 271-1080
Mailing address
1200 EUBANK BLVD NE, ALBUQUERQUE, NM 87112-5314
(505) 271-5050
(505) 271-1080
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
0892
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1194897108
INDIVIDUAL NPI
NM
Enumeration date
04/24/2007
Last updated
08/22/2020
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