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General NPI Number Information
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NPI Number | 1134971781
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Entity Type | Organization
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Legal Business Name | POWER THROUGH CHANGE LLC
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Dates
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Enumeration Date | 04/04/2024
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Last Update Date | 04/04/2024
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Provider Practice Location Address
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Address Line | 3800 HERITAGE AVE STE A2
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City | OKEMOS
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State | MI
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Zip | 48864-2871
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Country | US
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Telephone | 517-292-3824
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Fax |
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Provider Business Mailing Address
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Address Line | 1436 SAFIRE CT
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City | EAST LANSING
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State | MI
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Zip | 48823-6357
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. BLAKE MCCULLOUGH
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Credential | LMSW-C
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Telephone | 248-416-3323
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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