Provider Demographics
NPI:1992208623
Name:CONSULT 4 CHANGE LLC
Entity Type:Organization
Organization Name:CONSULT 4 CHANGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPC
Authorized Official - Prefix:MS
Authorized Official - First Name:LAJUANA
Authorized Official - Middle Name:E
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:313-590-5253
Mailing Address - Street 1:4802 E RAY RD SUITE 23-266
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044
Mailing Address - Country:US
Mailing Address - Phone:313-590-5253
Mailing Address - Fax:
Practice Address - Street 1:4802 E RAY RD SUITE 23-266
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-0620
Practice Address - Country:US
Practice Address - Phone:602-620-5507
Practice Address - Fax:602-491-2677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-08
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X, 251S00000X
AZLPC16755261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZL21933971OtherENTITY ID
AZ277387Medicaid