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Organization

CENTER FOR LIFE CHANGE

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. LORI EILEEN GROVES MMFT (MARRIAGE AND FAMILY THERAPIST)
(219) 866-7869
Entity
Organization

Contact information

Practice address
1317 15TH ST SE, DEMOTTE, IN 46310-9393
(219) 987-3719
(219) 987-7729
Mailing address
1103 EAST GRACE STREET, BUILDING 2, RENSSELAER, IN 47978
(219) 866-7869
(219) 866-0688

Taxonomy

Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
201049690A
IN
Enumeration date
08/26/2011
Last updated
04/24/2013
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