Provider Demographics
NPI:1043852510
Name:PRACTICAL CHOICES AND HEALTHY CHANGE THERAPY, LLC
Entity Type:Organization
Organization Name:PRACTICAL CHOICES AND HEALTHY CHANGE THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JO
Authorized Official - Middle Name:ANNA
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:251-591-2997
Mailing Address - Street 1:750 DOWNTOWNER BLVD FL 3
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36609-5457
Mailing Address - Country:US
Mailing Address - Phone:251-591-2997
Mailing Address - Fax:
Practice Address - Street 1:750 DOWNTOWNER BLVD FL 3
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-5457
Practice Address - Country:US
Practice Address - Phone:251-591-2997
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-16
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)