Provider Demographics
NPI:1295139822
Name:EFFECTIVE LIFE CHANGING COUNSELING
Entity type:Organization
Organization Name:EFFECTIVE LIFE CHANGING COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW
Authorized Official - Prefix:
Authorized Official - First Name:KORI
Authorized Official - Middle Name:ALLISON
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-772-9644
Mailing Address - Street 1:711 S CARSON ST STE 4
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89701-5292
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:711 S CARSON ST STE 4
Practice Address - Street 2:FPO
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89701-5292
Practice Address - Country:US
Practice Address - Phone:631-772-9644
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EFFECTIVE LIFE CHANGING COUNSELING
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-10-10
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60312005251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health