Provider Demographics
NPI:1417726134
Name:COUNSELING FOR CREATIVE CHANGE INC
Entity Type:Organization
Organization Name:COUNSELING FOR CREATIVE CHANGE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOSH
Authorized Official - Middle Name:
Authorized Official - Last Name:SINGER
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:916-595-8200
Mailing Address - Street 1:PO BOX 263
Mailing Address - Street 2:
Mailing Address - City:WEIMAR
Mailing Address - State:CA
Mailing Address - Zip Code:95736-0263
Mailing Address - Country:US
Mailing Address - Phone:916-595-8200
Mailing Address - Fax:
Practice Address - Street 1:22640 PINE LAKE DR
Practice Address - Street 2:
Practice Address - City:COLFAX
Practice Address - State:CA
Practice Address - Zip Code:95713-9041
Practice Address - Country:US
Practice Address - Phone:916-595-8200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-21
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)