Provider Demographics
NPI:1710493143
Name:NEW CONCEPTS FOR CHANGE
Entity Type:Organization
Organization Name:NEW CONCEPTS FOR CHANGE
Other - Org Name:NEW CONCEPTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLI
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:PEPELEA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:812-235-8744
Mailing Address - Street 1:1800 WABASH AVE
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47807-3325
Mailing Address - Country:US
Mailing Address - Phone:812-235-8744
Mailing Address - Fax:812-282-7258
Practice Address - Street 1:1800 WABASH AVE
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47807-3325
Practice Address - Country:US
Practice Address - Phone:812-235-8744
Practice Address - Fax:812-282-7258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-21
Last Update Date:2017-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN87001381A101YA0400X
IN34006237A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty