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General NPI Number Information
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NPI Number | 1033483391
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Entity Type | Organization
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Legal Business Name | THERAPEUTIC CHANGE
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Dates
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Enumeration Date | 03/05/2012
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Last Update Date | 03/05/2012
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Provider Practice Location Address
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Address Line | 3305 MAIN ST STE 24
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City | VANCOUVER
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State | WA
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Zip | 98663-2234
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Country | US
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Telephone | 360-602-1477
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Fax |
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Provider Business Mailing Address
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Address Line | 3305 MAIN ST STE 24
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City | VANCOUVER
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State | WA
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Zip | 98663-2234
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Country | US
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Telephone | 360-602-1477
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Fax |
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Authorized Official
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Title or Position | OWNER/CLINICIAN
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Name | SUMMER L BROWN
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Credential | M.S. LMFT
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Telephone | 360-602-1477
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LF60233689
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License Number State | WA
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