=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013706654
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SEEDS OF CHANGE COUNSELING, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/01/2025
-----------------------------------------------------
Last Update Date | 05/01/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 528 2ND ST
-----------------------------------------------------
City | HAMPTON
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68843-9336
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-629-2315
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 528 2ND ST
-----------------------------------------------------
City | HAMPTON
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68843-9336
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-629-2315
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/THERAPIST
-----------------------------------------------------
Name | ANDREA ROSE DE LA CRUZ
-----------------------------------------------------
Credential | LIMHP, LPC
-----------------------------------------------------
Telephone | 314-629-2315
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------