Provider Demographics
NPI:1629482112
Name:STEPS OF CHANGE LLC
Entity Type:Organization
Organization Name:STEPS OF CHANGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:J
Authorized Official - Last Name:SENTY
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPCC
Authorized Official - Phone:218-370-8773
Mailing Address - Street 1:PO BOX 283
Mailing Address - Street 2:1910 WEST HWY 61
Mailing Address - City:GRAND MARAIS
Mailing Address - State:MN
Mailing Address - Zip Code:55604-0283
Mailing Address - Country:US
Mailing Address - Phone:218-370-8773
Mailing Address - Fax:218-387-2248
Practice Address - Street 1:1910 WEST HWY 61
Practice Address - Street 2:
Practice Address - City:GRAND MARAIS
Practice Address - State:MN
Practice Address - Zip Code:55604-0283
Practice Address - Country:US
Practice Address - Phone:218-370-8773
Practice Address - Fax:218-387-2248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-12
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN00785101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty