Provider Demographics
NPI:1669047650
Name:CHANGES COUNSELING OF HARTLAND, LLC
Entity type:Organization
Organization Name:CHANGES COUNSELING OF HARTLAND, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTY
Authorized Official - Middle Name:R
Authorized Official - Last Name:RONALD
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:215-581-8880
Mailing Address - Street 1:5730 BELLA ROSA BLVD STE 500
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48348-4779
Mailing Address - Country:US
Mailing Address - Phone:215-581-8880
Mailing Address - Fax:248-297-5968
Practice Address - Street 1:5730 BELLA ROSA BLVD STE 500
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48348-4779
Practice Address - Country:US
Practice Address - Phone:215-581-8880
Practice Address - Fax:248-297-5968
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHANGES COUNSELING OF HARTLAND LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-05-24
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty