Healthcare Provider Details

I. General information

NPI: 1053630715
Provider Name (Legal Business Name): LASTING CHANGES COUNSELING CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2010
Last Update Date: 11/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 STATE ST
LA PORTE IN
46350-3115
US

IV. Provider business mailing address

PO BOX 861
LA PORTE IN
46352-0861
US

V. Phone/Fax

Practice location:
  • Phone: 219-362-5000
  • Fax: 219-362-5005
Mailing address:
  • Phone: 219-362-5000
  • Fax: 219-362-5005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: M HARPA HUNTRESS
Title or Position: OWNER/SECRETARY
Credential: LMHC
Phone: 219-362-5000