=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215827340
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE CHANGE LAB COUNSELING AND CONSULTING PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/09/2025
-----------------------------------------------------
Last Update Date | 07/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3030 S COLLEGE AVE UNIT 207
-----------------------------------------------------
City | FORT COLLINS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80525-2557
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-297-0020
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3030 S COLLEGE AVE UNIT 207
-----------------------------------------------------
City | FORT COLLINS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80525-2557
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRACTICE OWNER/COUNSELOR
-----------------------------------------------------
Name | LARISSA CAMBEL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 970-829-5853
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0850X
-----------------------------------------------------
Taxonomy Name | Adult Mental Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------