Provider Demographics
NPI:1437666096
Name:SEED OF CHANGE COUNSELING AND NEUROTHERAPY, PLLC
Entity Type:Organization
Organization Name:SEED OF CHANGE COUNSELING AND NEUROTHERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, LPC
Authorized Official - Phone:719-629-8574
Mailing Address - Street 1:2906 BEACON ST STE B
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-6193
Mailing Address - Country:US
Mailing Address - Phone:719-629-8574
Mailing Address - Fax:719-213-2839
Practice Address - Street 1:2906 BEACON ST STE B
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-6193
Practice Address - Country:US
Practice Address - Phone:719-629-8574
Practice Address - Fax:719-213-2839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-04
Last Update Date:2018-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0012243101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty