Provider Demographics
NPI:1881292076
Name:MEANINGFUL CHANGE: CLINICAL & CONSULTATION PSYCHOLOGY, PLLC
Entity type:Organization
Organization Name:MEANINGFUL CHANGE: CLINICAL & CONSULTATION PSYCHOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAHAM
Authorized Official - Middle Name:RAUL
Authorized Official - Last Name:SOL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LP
Authorized Official - Phone:989-824-6565
Mailing Address - Street 1:600 E BROADWAY ST STE 107
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-2776
Mailing Address - Country:US
Mailing Address - Phone:989-824-6565
Mailing Address - Fax:833-647-2020
Practice Address - Street 1:600 E BROADWAY ST STE 107
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-2776
Practice Address - Country:US
Practice Address - Phone:989-824-6565
Practice Address - Fax:833-647-2020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-11
Last Update Date:2021-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty