Provider Demographics
NPI:1891152344
Name:COURAGE TO CHANGE LLC
Entity Type:Organization
Organization Name:COURAGE TO CHANGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:L
Authorized Official - Last Name:DENAEYER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:307-756-2956
Mailing Address - Street 1:805 MOUNTAIN VIEW DR APT 107
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82716-2339
Mailing Address - Country:US
Mailing Address - Phone:307-756-2956
Mailing Address - Fax:
Practice Address - Street 1:113 S GILLETTE AVE
Practice Address - Street 2:STE 200
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82716-3740
Practice Address - Country:US
Practice Address - Phone:307-756-2956
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-27
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY716261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)