Provider Demographics
NPI:1710687413
Name:COMMITTING TO CHANGE COUNSELING AND RECOVERY LLC
Entity Type:Organization
Organization Name:COMMITTING TO CHANGE COUNSELING AND RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:MCNICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:LIMHP, LADC
Authorized Official - Phone:402-440-6496
Mailing Address - Street 1:770 N COTNER BLVD STE 116
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68505-2344
Mailing Address - Country:US
Mailing Address - Phone:402-217-3086
Mailing Address - Fax:
Practice Address - Street 1:770 N COTNER BLVD STE 116
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68505-2344
Practice Address - Country:US
Practice Address - Phone:402-217-3086
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-09
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty