Provider Demographics
NPI:1912568486
Name:LEAVES OF CHANGE COUNSELING LLC
Entity Type:Organization
Organization Name:LEAVES OF CHANGE COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:413-636-3829
Mailing Address - Street 1:16 CENTER ST STE 517
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-3589
Mailing Address - Country:US
Mailing Address - Phone:413-636-3829
Mailing Address - Fax:
Practice Address - Street 1:16 CENTER ST STE 517
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-3589
Practice Address - Country:US
Practice Address - Phone:413-636-3829
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LEAVES OF CHANGE COUNSELING LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-06-25
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty