Provider Demographics
NPI:1235480500
Name:TRUE LEADERS OF CHANGE CONSULTING SERVICES,LLC
Entity Type:Organization
Organization Name:TRUE LEADERS OF CHANGE CONSULTING SERVICES,LLC
Other - Org Name:TRUE LEADERS OF CHANGE CONSULTING SERVICES, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:CADC, CAM1
Authorized Official - Phone:773-459-6452
Mailing Address - Street 1:2436 W 59TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60629-1136
Mailing Address - Country:US
Mailing Address - Phone:773-459-6452
Mailing Address - Fax:
Practice Address - Street 1:2436 W. 59TH ST.
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60629
Practice Address - Country:US
Practice Address - Phone:773-459-6452
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-27
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILA-5822-0001-A252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency