Provider Demographics
NPI:1245557941
Name:CHANGING LIVES COUNSELING LLC
Entity Type:Organization
Organization Name:CHANGING LIVES COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:TOLTZMAN KNAPP
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC, NCC
Authorized Official - Phone:920-393-4148
Mailing Address - Street 1:715 SUPERIOR RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54311-7595
Mailing Address - Country:US
Mailing Address - Phone:920-393-4148
Mailing Address - Fax:920-393-4244
Practice Address - Street 1:715 SUPERIOR RD
Practice Address - Street 2:SUITE 101
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54311-7595
Practice Address - Country:US
Practice Address - Phone:920-393-4148
Practice Address - Fax:920-393-4244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-21
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4380-125251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health