Organization Active NPI

True Life Change

  • Mental Health Counselor
  • Frederick, MD
National Provider Identifier
1285304626
Registry record updated Sep 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
TRUE LIFE CHANGE
Practice address
5100 Buckeystown Pike Ste 250
Frederick, MD 21704-8344
Phone
(410) 417-7556
NPI assigned
Sep 16, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 20, 2021

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

Authorized official

Name
Marsha Holevas
Title
Administrator
Phone
(443) 418-9957

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X Primary

Addresses

Primary practice location

5100 Buckeystown Pike Ste 250
Frederick, MD 21704-8344

Mailing address

5100 Buckeystown Pike Ste 250
Frederick, MD 21704-8344

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL therapy@truelifechange.net Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220207002033 MD Part B Supplier - Clinic/Group Practice 1759774128 Receives reassigned benefits from 5 practitioners
Practice locations: Frederick, MD

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 7

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

NPI Registry JSON

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

{
    "created_epoch": "1631750400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632096000000",
    "number": "1285304626",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5100 BUCKEYSTOWN PIKE STE 250",
            "city": "FREDERICK",
            "state": "MD",
            "postal_code": "217048344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5100 BUCKEYSTOWN PIKE STE 250",
            "city": "FREDERICK",
            "state": "MD",
            "postal_code": "217048344",
            "telephone_number": "410-417-7556"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRUE LIFE CHANGE",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-16",
        "last_updated": "2021-09-20",
        "certification_date": "2021-09-20",
        "status": "A",
        "authorized_official_last_name": "HOLEVAS",
        "authorized_official_first_name": "MARSHA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "443-418-9957"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "therapy@truelifechange.net",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "5100 Buckeystown Pike",
            "city": "Frederick",
            "state": "MD",
            "country_code": "US",
            "postal_code": "217048336",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Frederick, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2021; 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.