Change Your Life Enterprises, Inc.

Primary specialty

Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X

License

547 Issued in KS

Legal business name

CHANGE YOUR LIFE ENTERPRISES, INC.

Doing business as

ADAPT, GRIP & Stephenie Roberts, LSCSW

Practice address

9505 W. Central
Ste. 103
Wichita, KS 67212-3832

Phone

(316) 721-0971

Fax

(316) 512-4070

NPI assigned

Jan 10, 2006

Last updated

Jul 15, 2011By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Stephenie Ann Roberts, LSCSWNPI 1083693956

Title

President/Owner

Phone

(316) 721-0971

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• ADAPT, GRIP & Stephenie Roberts, LSCSW Doing business as

Medicare fee-for-service enrollment

Enrolled in KS

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Stephenie Ann Roberts, LSCSW

  • Clinical Social Worker
  • Wichita, KS
  • NPI 1083693956

  Addiction (Substance Use Disorder)

  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1136851200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1310688000000",
    "number": "1003895988",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9505 W. CENTRAL",
            "address_2": "STE. 103",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672123832",
            "telephone_number": "316-721-0971",
            "fax_number": "316-512-4070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9505 W. CENTRAL",
            "address_2": "STE. 103",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672123832",
            "telephone_number": "316-721-0971",
            "fax_number": "316-512-4070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHANGE YOUR LIFE ENTERPRISES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-10",
        "last_updated": "2011-07-15",
        "status": "A",
        "authorized_official_last_name": "ROBERTS",
        "authorized_official_first_name": "STEPHENIE",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "316-721-0971",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LSCSW"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "KS",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "KS",
            "license": "1949",
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "KS",
            "license": "547",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "565012",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ADAPT, GRIP & Stephenie Roberts, LSCSW",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Howard Y Chang, MD
• Irene L Chang, MD
• Joseph Patrick Chang, DDS.
• Maria Corazon Chang, M.D.
• Mary Ann Chang, DMD, MDS
• Changing Habits
• Raymond Chankalal, MD
• Travis Kent Channell
• Hemalatha Chaparala, M.D
• Raghu C Chaparala, M.D.

• Substance Use Disorder Rehabilitation Clinic/Center in Wichita, KS
• Providers in Wichita, KS by specialty
• Substance Use Disorder Rehabilitation Clinic/Center in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.