Provider Demographics
NPI:1457406613
Name:COURAGE TO CHANGE, INC.
Entity Type:Organization
Organization Name:COURAGE TO CHANGE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:T
Authorized Official - Last Name:TIPTON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:606-877-9008
Mailing Address - Street 1:474 BARBOURVILLE RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40744-9302
Mailing Address - Country:US
Mailing Address - Phone:606-877-9008
Mailing Address - Fax:606-877-1785
Practice Address - Street 1:474 BARBOURVILLE RD
Practice Address - Street 2:SUITE 2
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40744-9302
Practice Address - Country:US
Practice Address - Phone:606-877-9008
Practice Address - Fax:606-877-1785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3300106600320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities