Provider Demographics
NPI:1740316975
Name:INSTITUTE FOR CHANGE, P.C.
Entity type:Organization
Organization Name:INSTITUTE FOR CHANGE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:D
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:303-933-9104
Mailing Address - Street 1:3500 S WADSWORTH BLVD
Mailing Address - Street 2:403
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80235-2019
Mailing Address - Country:US
Mailing Address - Phone:303-933-9104
Mailing Address - Fax:
Practice Address - Street 1:3500 S WADSWORTH BLVD
Practice Address - Street 2:403
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80235-2019
Practice Address - Country:US
Practice Address - Phone:303-933-9104
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO247106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty