Lifechange Psychological Services, LLC

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

1088 Issued in OK

Legal business name

LIFECHANGE PSYCHOLOGICAL SERVICES, LLC

Practice address

4117 NW 122ND St Ste A1
Oklahoma City, OK 73120-8819

Phone

(405) 562-9260

Fax

(405) 260-9559

NPI assigned

Aug 10, 2017

Last updated

Jan 23, 2021By 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

Dr. Chuck Edgington, PH.D.

Title

Owner

Phone

(405) 315-5756

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 2

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.

• Carl Robert Edgington, PHD

  • Clinical Psychologist
  • Salt Lake City, UT
  • NPI 1427285444
  NPD
• Melanie Camille Talley, PH.D.

  • Clinical Neuropsychologist
  • Oklahoma City, OK
  • NPI 1659528834
  NPD (past)

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

{
    "created_epoch": "1502323200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1611360000000",
    "number": "1295250207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3612 LEA CT",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "730138127"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4117 NW 122ND ST STE A1",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731208819",
            "telephone_number": "405-562-9260",
            "fax_number": "405-260-9559"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFECHANGE PSYCHOLOGICAL SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-10",
        "last_updated": "2021-01-23",
        "certification_date": "2021-01-23",
        "status": "A",
        "authorized_official_last_name": "EDGINGTON",
        "authorized_official_first_name": "CHUCK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "405-315-5756",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Clinical Neuropsychologist",
            "state": "OK",
            "license": "1088",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200254090A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Clinical Neuropsychologist in Oklahoma City, OK
• Providers in Oklahoma City, OK by specialty
• Clinical Neuropsychologist in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.