Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Life Change Associates, PC

Organization Mental Health Counselor · NPI 1598077562

Life Change Associates, PC is a Mental Health Counselor in Pocatello, Idaho. Licensed in Idaho. Registered with an NPI since 2010.

Licensed in
ID
In the registry since
2010
Specialties on file
3
What do these letters mean?
PC — Professional corporation
A form of business registration, not a clinical qualification.

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Practice location Address checks out

1777 E Clark St Ste 330
Pocatello, ID 83201-3357
Phone: (208) 233-5433
Fax: (877) 284-2783
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Psychiatry Physician (primary) Taxonomy 2084P0800X (ID)
Mental Health Counselor Taxonomy 101YM0800X (ID)
Physician Assistant Taxonomy 363A00000X (ID)

Record details

NPI number1598077562
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Deric Ravsten — Owner · (208) 233-5433
NPI enumeratedJuly 7, 2010
Last updated in NPPESNovember 23, 2013
Mailing address1777 E Clark St, Suite 330, Pocatello, ID 83201-3357

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