MEDICARE: BE THE CHANGE COUNSELING SERVICES, 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	:	1891517793
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BE THE CHANGE COUNSELING SERVICES, LLC

Provider Business Mailing Address
First Line	:	6290 LEHMAN DR STE 202-2
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-1471
Country	:	US
Telephone Number	:	719-401-2411
Fax Number	:

Provider Business Practice Location Address
First Line	:	6290 LEHMAN DR STE 202-2
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-1471
Country	:	US
Telephone Number	:	719-401-2411
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ERICKA LATHAM
Credential	:	MA, LPC, LMHC
Telephone Number	:	719-401-2411

Provider Enumeration Date	:	10/30/2024
Last Update Date	:	10/30/2024

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