Healthcare Provider Details

I. General information

NPI: 1932671849
Provider Name (Legal Business Name): RIVER OF CHANGE COUNSELING AND LIFE COACHING SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2018
Last Update Date: 05/20/2021
Certification Date: 05/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6767 W GREENFIELD AVE STE LL1
WEST ALLIS WI
53214-4967
US

IV. Provider business mailing address

6767 W GREENFIELD AVE STE LL1
WEST ALLIS WI
53214-4967
US

V. Phone/Fax

Practice location:
  • Phone: 414-455-3003
  • Fax: 414-455-3151
Mailing address:
  • Phone: 414-475-7830
  • Fax: 414-475-7917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: SARAH HILLMERT-GALLITZ
Title or Position: PRESIDENT
Credential:
Phone: 414-475-7830