Healthcare Provider Details

I. General information

NPI: 1790637510
Provider Name (Legal Business Name): A CHANCE FOR CHANGE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2026
Last Update Date: 02/12/2026
Certification Date: 02/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 N LAKE AVE
COLBY KS
67701-2433
US

IV. Provider business mailing address

345 N LAKE AVE
COLBY KS
67701-2433
US

V. Phone/Fax

Practice location:
  • Phone: 785-405-9052
  • Fax:
Mailing address:
  • Phone: 785-405-9052
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: JEANIE WITT
Title or Position: PROGRAM MANAGER/ADDICTION COUNSELOR
Credential: M.S., LAC
Phone: 785-405-9052