Provider Demographics
NPI:1275093858
Name:A CHANCE 4 CHANGE
Entity Type:Organization
Organization Name:A CHANCE 4 CHANGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:OSEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:208-944-9776
Mailing Address - Street 1:459 LOCUST ST N STE 108
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-7324
Mailing Address - Country:US
Mailing Address - Phone:208-944-9776
Mailing Address - Fax:208-481-8489
Practice Address - Street 1:459 LOCUST ST N STE 108
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-7324
Practice Address - Country:US
Practice Address - Phone:208-944-9776
Practice Address - Fax:208-481-8489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-21
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID37121OtherLICENSE