Provider Demographics
NPI:1659991727
Name:BE THE CHANGE HEALTH AND WELLNESS, LLC
Entity Type:Organization
Organization Name:BE THE CHANGE HEALTH AND WELLNESS, LLC
Other - Org Name:BE THE CHANGE HEALTH AND WELLNESS
Other - Org Type:Other Name
Authorized Official - Title/Position:CLINICAL SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:JOELLE
Authorized Official - Middle Name:KATHLEEN
Authorized Official - Last Name:OTTOSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:262-719-7609
Mailing Address - Street 1:240 N MILWAUKEE ST # 202
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-5830
Mailing Address - Country:US
Mailing Address - Phone:262-646-8288
Mailing Address - Fax:
Practice Address - Street 1:240 N MILWAUKEE ST # 202
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-5830
Practice Address - Country:US
Practice Address - Phone:262-646-8288
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-19
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1013302611OtherNPI
1487818086OtherNPI
1679591416OtherNPI
1013343870OtherNPI
1134147952OtherNPI
1194273888OtherNPI