Provider Demographics
NPI:1346815909
Name:A CONSCIOUS CHANGE COUNSELING AND WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:A CONSCIOUS CHANGE COUNSELING AND WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LATRICE
Authorized Official - Middle Name:
Authorized Official - Last Name:BAXTER
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMHC, LPC
Authorized Official - Phone:317-395-3716
Mailing Address - Street 1:201 N. ILLINOIS STREET
Mailing Address - Street 2:16TH FLOOR, SOUTH TOWER
Mailing Address - City:INDIANAPLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46204
Mailing Address - Country:US
Mailing Address - Phone:317-395-3716
Mailing Address - Fax:
Practice Address - Street 1:201 N. ILLINOIS STREET
Practice Address - Street 2:16TH FLOOR, SOUTH TOWER
Practice Address - City:INDIANAPLIS
Practice Address - State:IN
Practice Address - Zip Code:46204
Practice Address - Country:US
Practice Address - Phone:317-395-3716
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-25
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health