Provider Demographics
NPI:1205232238
Name:CHANGES COUNSELING OF HARTLAND LLC
Entity Type:Organization
Organization Name:CHANGES COUNSELING OF HARTLAND LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:RONALD
Authorized Official - Suffix:
Authorized Official - Credentials:LPC NCC
Authorized Official - Phone:810-475-2005
Mailing Address - Street 1:12319 HIGHLAND RD
Mailing Address - Street 2:SUITE 401
Mailing Address - City:HARTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48353-2946
Mailing Address - Country:US
Mailing Address - Phone:810-475-2005
Mailing Address - Fax:
Practice Address - Street 1:12319 HIGHLAND RD
Practice Address - Street 2:SUITE 401
Practice Address - City:HARTLAND
Practice Address - State:MI
Practice Address - Zip Code:48353-2946
Practice Address - Country:US
Practice Address - Phone:810-475-2005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-19
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401012837101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty