Provider Demographics
NPI:1053630715
Name:LASTING CHANGES COUNSELING CENTER, LLC
Entity Type:Organization
Organization Name:LASTING CHANGES COUNSELING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:M HARPA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUNTRESS
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:219-362-5000
Mailing Address - Street 1:PO BOX 861
Mailing Address - Street 2:
Mailing Address - City:LA PORTE
Mailing Address - State:IN
Mailing Address - Zip Code:46352-0861
Mailing Address - Country:US
Mailing Address - Phone:219-362-5000
Mailing Address - Fax:219-362-5005
Practice Address - Street 1:1501 STATE ST
Practice Address - Street 2:
Practice Address - City:LA PORTE
Practice Address - State:IN
Practice Address - Zip Code:46350-3115
Practice Address - Country:US
Practice Address - Phone:219-362-5000
Practice Address - Fax:219-362-5005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-20
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty