Provider Demographics
NPI:1164986121
Name:CONDITIONS FOR CHANGE LLC
Entity Type:Organization
Organization Name:CONDITIONS FOR CHANGE LLC
Other - Org Name:MINDFUL PSYCHOTHERAPY & TRAUMA RESOLUTION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:ERICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:610-427-0698
Mailing Address - Street 1:35 BROOK CIR
Mailing Address - Street 2:
Mailing Address - City:GLENMOORE
Mailing Address - State:PA
Mailing Address - Zip Code:19343-1204
Mailing Address - Country:US
Mailing Address - Phone:610-427-0698
Mailing Address - Fax:
Practice Address - Street 1:35 BROOK CIR
Practice Address - Street 2:
Practice Address - City:GLENMOORE
Practice Address - State:PA
Practice Address - Zip Code:19343-1204
Practice Address - Country:US
Practice Address - Phone:610-427-0698
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-24
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No171400000XOther Service ProvidersHealth & Wellness CoachGroup - Multi-Specialty