Provider Demographics
NPI:1457458721
Name:A CHANGE COUNSELING CENTER INC.
Entity Type:Organization
Organization Name:A CHANGE COUNSELING CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:J
Authorized Official - Last Name:BROUSSARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-473-1844
Mailing Address - Street 1:4002 S M ST STE C
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98418-3800
Mailing Address - Country:US
Mailing Address - Phone:253-473-1844
Mailing Address - Fax:253-473-1839
Practice Address - Street 1:4002 S M ST STE C
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98418-3800
Practice Address - Country:US
Practice Address - Phone:253-473-1844
Practice Address - Fax:253-473-1839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00000521101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1328OtherPREMERA BLUE CROSS ID