Provider Demographics
NPI:1699822353
Name:CHOICES FOR CHANGE COUNSELING AGENCY LPC
Entity Type:Organization
Organization Name:CHOICES FOR CHANGE COUNSELING AGENCY LPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:IRIS
Authorized Official - Last Name:SERLIN
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:269-344-7997
Mailing Address - Street 1:218 W WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-5131
Mailing Address - Country:US
Mailing Address - Phone:269-344-7997
Mailing Address - Fax:269-344-8642
Practice Address - Street 1:218 W WALNUT ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-5131
Practice Address - Country:US
Practice Address - Phone:269-344-7997
Practice Address - Fax:269-344-8642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOM96560Medicare PIN