Lifechangers Outreach

Primary specialty

Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X

License

1000000021300 Issued in TN

Legal business name

LIFECHANGERS OUTREACH

Doing business as

LifeChangers IOP

Practice address

2450 Winfield Dunn Pkwy
Kodak, TN 37764-2100

Phone

(865) 805-0567

NPI assigned

Dec 19, 2017

Last updated

Sep 25, 2018By 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

Matthew Johnson, M.A., M.DIVNPI 1467179929

Title

Executive Director

Phone

(865) 805-0567

Specialties & licenses 1

Addresses

Other names 1

• LifeChangers IOP Doing business as

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.

• Matthew Johnson, M.A., M.DIV

  • Addiction (Substance Use Disorder) Counselor
  • Kodak, TN
  • NPI 1467179929
  NPD Authorized official

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

{
    "created_epoch": "1513641600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1537833600000",
    "number": "1790291334",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "404 HOLLY CT",
            "city": "SEVIERVILLE",
            "state": "TN",
            "postal_code": "378625314"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2450 WINFIELD DUNN PKWY",
            "city": "KODAK",
            "state": "TN",
            "postal_code": "377642100",
            "telephone_number": "865-805-0567"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3677 Robert C. Byrd Drive",
            "address_purpose": "LOCATION",
            "city": "Beckley",
            "state": "WV",
            "postal_code": "25801",
            "country_code": "US",
            "telephone_number": "865-805-0567",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LIFECHANGERS OUTREACH",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-12-19",
        "last_updated": "2018-09-25",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "865-805-0567",
        "authorized_official_credential": "M.A., M.DIV"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "TN",
            "license": "1000000021300",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LifeChangers IOP",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• K VA T Food Stores Inc
• Kodak Family Dental, PLLC (Kodak Dental Care)
• Joseph Laznik, PT
• Doreen Georgina Leo-Huneke, L.C.S.W.
• Karen Lynn Lester, FNP-BC
• Ethan Michael Long, DDS
• Ashlyn Jones Loy, PHARMD.
• Kenna Nicole Major, APRN
• Mica Mathison, DMD
• Elizabeth Coleen McDonald

• Substance Use Disorder Rehabilitation Clinic/Center in Kodak, TN
• Providers in Kodak, TN by specialty
• Substance Use Disorder Rehabilitation Clinic/Center in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2018; 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.