The Life Change Center

Primary specialty

Addiction (Substance Use Disorder) PsychologistTaxonomy code 103TA0400X

License

138101 Issued in NV

Legal business name

THE LIFE CHANGE CENTER

Practice address

130 Vine St
Reno, NV 89503-5546

Phone

(775) 499-5534

Fax

(775) 355-7759

NPI assigned

May 5, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Ryan Zeller, DONPI 1346372760

Title

Medical Director

Phone

(775) 355-7734

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• American Therapeutic Association Former legal business name

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
  • Sparks, NV
  • NPI 1205389129

  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
  • Sparks, NV
  • NPI 1205389129

  O20061005000586, O20200406002388

  Same enrollment
• The Life Change Center

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

  O20061005000586, O20200406002388

  Same enrollment

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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
  • Sparks, NV
  • NPI 1205389129
  NPD tax ID
• The Life Change Center

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

Locations

Practitioners 5

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

• Ryan P Zeller, DO

  • Family Medicine Physician
  • Sparks, NV
  • NPI 1346372760
  Medicare reassignment NPD Authorized official
• Melissa Cordova Segoviano, CADC-I

  • Addiction (Substance Use Disorder) Counselor
  • Reno, NV
  • NPI 1144184847
  NPD (past)
• Kiara Pontius

  • Addiction (Substance Use Disorder) Counselor
  • Reno, NV
  • NPI 1265202774
  NPD (past)
• Megan Seivert, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Reno, NV
  • NPI 1992262778
  NPD (past)
• Brennan Tica

  • Addiction (Substance Use Disorder) Counselor
  • Reno, NV
  • NPI 1285401885
  NPD (past)

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

{
    "created_epoch": "1146787200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718582400000",
    "number": "1922056415",
    "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": "775-355-7734",
            "fax_number": "775-355-7759"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 VINE ST",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895035546",
            "telephone_number": "775-499-5534",
            "fax_number": "775-355-7759"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1755 Sullivan Ln",
            "address_purpose": "LOCATION",
            "city": "Sparks",
            "state": "NV",
            "postal_code": "894312815",
            "country_code": "US",
            "telephone_number": "775-355-7734",
            "fax_number": "775-355-7759",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "THE LIFE CHANGE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-05",
        "last_updated": "2024-06-17",
        "certification_date": "2024-06-17",
        "status": "A",
        "authorized_official_last_name": "ZELLER",
        "authorized_official_first_name": "RYAN",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "775-355-7734",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "103TA0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Addiction (Substance Use Disorder)",
            "state": "NV",
            "license": "138101",
            "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": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001716006",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "American Therapeutic Association",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "American Therapeutic Association",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• The Fern House LLC
• The Finley Center
• The Gatlin Spirit House
• The Gatlin Spirit House
• The Hawthorne Group Inc
• The Lippert Home
• The Medical Profession, LLC
• The Nevada Center for Reproductive Medicine
• The Next Step Therapy Limited
• The Northern NV Endoscopy ASC LLC

• Addiction (Substance Use Disorder) Psychologist in Reno, NV
• Providers in Reno, 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.