MEDICARE: CHANGE COURSE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1831042704
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHANGE COURSE, LLC

Provider Business Mailing Address
First Line	:	5494 BROWN RD STE 112
Second Line	:
City	:	HAZELWOOD
State	:	MO
Zip	:	63042-1100
Country	:	US
Telephone Number	:	314-203-0744
Fax Number	:

Provider Business Practice Location Address
First Line	:	7801 SKYVIEW DR
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63121-1307
Country	:	US
Telephone Number	:	314-203-0744
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ISRAELNEISHA ELEBY
Credential	:	LPC
Telephone Number	:	314-203-0744

Provider Enumeration Date	:	02/19/2026
Last Update Date	:	02/19/2026

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