Provider Demographics
NPI:1851336739
Name:COUNSELING FOR GROWTH AND CHANGE, LC
Entity Type:Organization
Organization Name:COUNSELING FOR GROWTH AND CHANGE, LC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TONI
Authorized Official - Middle Name:R
Authorized Official - Last Name:BELL
Authorized Official - Suffix:
Authorized Official - Credentials:MA,LMHC
Authorized Official - Phone:515-243-1020
Mailing Address - Street 1:6900 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:WINDSOR HEIGHTS
Mailing Address - State:IA
Mailing Address - Zip Code:50311-1505
Mailing Address - Country:US
Mailing Address - Phone:515-243-1020
Mailing Address - Fax:515-883-1946
Practice Address - Street 1:6900 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:WINDSOR HEIGHTS
Practice Address - State:IA
Practice Address - Zip Code:50311-1505
Practice Address - Country:US
Practice Address - Phone:515-243-1020
Practice Address - Fax:515-883-1946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0103820Medicaid