The Life Change Center

Primary specialty

Addiction (Substance Use Disorder) PsychologistTaxonomy code 103TA0400X

License

8312NTC-01 Issued in NV

Legal business name

THE LIFE CHANGE CENTER

Practice address

1755 Sullivan LN
Sparks, NV 89431-2815

Phone

(775) 499-5534

Fax

(775) 499-5535

NPI assigned

Jul 27, 2016

Organization subpart

No

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

Authorized official

Name

Mr. John Firestone, MSW, LADC

Title

Executive Director

Phone

(775) 842-7436

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in NV2 enrollments

Opioid treatment program

Medicare-enrolled since Jan 1, 2020

Enrollment records 2

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• The Life Change Center

  • Addiction (Substance Use Disorder) Psychologist
  • Reno, NV
  • NPI 1922056415

  4183620602

  Same PAC ID

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• The Life Change Center

  • Addiction (Substance Use Disorder) Psychologist
  • Carson City, NV
  • NPI 1841743762

  O20061005000586, O20200406002388

  Same enrollment
• The Life Change Center

  • Addiction (Substance Use Disorder) Psychologist
  • Reno, NV
  • NPI 1922056415

  O20061005000586, O20200406002388

  Same enrollment

Tax ID family

The Life Change Center4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

• The Life Change Center

  • Addiction (Substance Use Disorder) Psychologist
  • Carson City, NV
  • NPI 1073978151
  NPD tax ID
• The Life Change Center

  • Addiction (Substance Use Disorder) Psychologist
  • Carson City, NV
  • NPI 1841743762
  NPD tax ID
• The Life Change Center

  • Addiction (Substance Use Disorder) Psychologist
  • Reno, NV
  • NPI 1922056415
  NPD tax ID

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Megan Seivert, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Reno, NV
  • NPI 1992262778
  NPD
• Ryan P Zeller, DO

  • Family Medicine Physician
  • Sparks, NV
  • NPI 1346372760
  NPD

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

{
    "created_epoch": "1469577600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718582400000",
    "number": "1205389129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1755 SULLIVAN LN",
            "city": "SPARKS",
            "state": "NV",
            "postal_code": "894312815",
            "telephone_number": "775-499-5534",
            "fax_number": "775-499-5535"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1755 SULLIVAN LN",
            "city": "SPARKS",
            "state": "NV",
            "postal_code": "894312815",
            "telephone_number": "775-499-5534",
            "fax_number": "775-499-5535"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE LIFE CHANGE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-27",
        "last_updated": "2024-06-17",
        "certification_date": "2024-06-17",
        "status": "A",
        "authorized_official_last_name": "FIRESTONE",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "775-842-7436",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MSW, LADC"
    },
    "taxonomies": [
        {
            "code": "103TA0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Addiction (Substance Use Disorder)",
            "state": "NV",
            "license": "8312NTC-01",
            "primary": true
        },
        {
            "code": "261QM2800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Methadone",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chelsea Terrell
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• Sandie Lee Thatcher
• Lisa Thayer, APRN
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• Alicia Thomas

• Addiction (Substance Use Disorder) Psychologist in Sparks, NV
• Providers in Sparks, NV by specialty
• Addiction (Substance Use Disorder) Psychologist in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2024; 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.