Life Change Associates, PC

NPI #1598077562 in Pocatello, Idaho

Provider Information

NPI Number: 1598077562
Entity Type: Organization
Organization Name: Life Change Associates, PC
Primary Specialty: Psychiatry & Neurology - Psychiatry
Enumeration Date: Jul 7, 2010
Last Updated: Nov 23, 2013

Practice Location

Address: 1777 E CLARK ST
Address 2: SUITE 330
City: Pocatello
State: Idaho
ZIP Code: 83201-3357
Phone: (208) 233-5433

Authorized Official

Name: DR. DERIC V RAVSTEN, DO
Title: OWNER
Phone: (208) 233-5433

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Counselor - Mental Health — Mental Health	101YM0800X
Physician Assistant	363A00000X
Psychiatry & Neurology - Psychiatry — Psychiatry	2084P0800X	Primary

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