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General NPI Number Information
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NPI Number | 1144802521
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Entity Type | Organization
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Legal Business Name | CHANGING PHASES, LLC
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Dates
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Enumeration Date | 04/25/2021
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Last Update Date | 03/08/2024
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Provider Practice Location Address
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Address Line | 142 HAWLEY ST STE 1
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City | GRAYSLAKE
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State | IL
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Zip | 60030-3653
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Country | US
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Telephone | 224-421-6235
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Fax | 630-349-8131
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Provider Business Mailing Address
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Address Line | 142 HAWLEY ST STE 1
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City | GRAYSLAKE
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State | IL
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Zip | 60030-3653
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Country | US
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Telephone | 224-421-6235
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Fax | 630-349-8131
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Authorized Official
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Title or Position | MEMBER
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Name | JUSTIN WILLIAM SCHLOER
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Credential |
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Telephone | 224-421-6235
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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