Provider Demographics
NPI:1396597092
Name:INSIGHTFUL CHANGES COUNSELING, LLC
Entity type:Organization
Organization Name:INSIGHTFUL CHANGES COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAITLEE
Authorized Official - Middle Name:
Authorized Official - Last Name:DERX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-307-8403
Mailing Address - Street 1:94 FOREST MEADOW TRL
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14624-1137
Mailing Address - Country:US
Mailing Address - Phone:716-307-8403
Mailing Address - Fax:
Practice Address - Street 1:94 FOREST MEADOW TRL
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14624-1137
Practice Address - Country:US
Practice Address - Phone:716-307-8403
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-04
Last Update Date:2024-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty