OrganizationActive
Change of Life
NPI 1245199975 · Mental Health Clinic/Center (Including Community Mental Health Center) · Indianola, MS
Provider details
- NPI number
- 1245199975
- Entity type
- Organization
- Primary specialty
- Mental Health Clinic/Center (Including Community Mental Health Center)Ambulatory Health Care Facilities
- Organization subpart
- No
- Authorized official
- Pamela Randle, Ceo(662) 207-3645
Specialties & taxonomies
Ambulatory Health Care Facilities
Profile Score
Established profile(53/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
Under 1 yr in registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
411 Roosevelt St
Indianola, MS 38751-3141
Phone: (662) 635-9972
Fax: (662) 452-5066
Street-level locationGet directions
Mailing address
411 Roosevelt St
Indianola, MS 38751-3141
Registry dates
- Enumerated
- 2026-01-19
- Last updated
- 2026-01-19
- Certified
- 2026-01-19
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.