Healthcare Provider Details

I. General information

NPI: 1326560970
Provider Name (Legal Business Name): CHANGE THROUGH TRANSITION, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2017
Last Update Date: 06/23/2023
Certification Date: 06/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3375 MERRIAM ST STE 202
MUSKEGON MI
49444-3173
US

IV. Provider business mailing address

PO BOX 150137
GRAND RAPIDS MI
49515-0137
US

V. Phone/Fax

Practice location:
  • Phone: 586-467-0447
  • Fax:
Mailing address:
  • Phone: 616-821-8111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number6801057813
License Number StateMI

VIII. Authorized Official

Name: DR. ELAINE MARIE BEAUCHAMP
Title or Position: DIRECTOR
Credential: SOCIAL WORKER
Phone: 616-222-0851