Provider Demographics
NPI:1356190904
Name:NEW CHANGES LLC
Entity type:Organization
Organization Name:NEW CHANGES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOTHERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:BOBBIE JO
Authorized Official - Middle Name:L
Authorized Official - Last Name:BLESER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, CSAC
Authorized Official - Phone:920-530-4433
Mailing Address - Street 1:2373 YOLANDA CIR
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54303-6202
Mailing Address - Country:US
Mailing Address - Phone:920-676-6447
Mailing Address - Fax:920-688-4261
Practice Address - Street 1:3311 PACKERLAND DR STE A
Practice Address - Street 2:#19
Practice Address - City:DE PERE
Practice Address - State:WI
Practice Address - Zip Code:54115-9539
Practice Address - Country:US
Practice Address - Phone:920-530-4433
Practice Address - Fax:920-688-4261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-16
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100021415Medicaid