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General NPI Number Information
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NPI Number | 1245925411
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Entity Type | Organization
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Legal Business Name | CREATING CHANGE COUNSELING AND EDUCATION, LLC
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Dates
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Enumeration Date | 04/05/2023
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Last Update Date | 04/24/2023
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Provider Practice Location Address
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Address Line | 139 REGENCY BLVD
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City | PUEBLO
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State | CO
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Zip | 81005-2127
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Country | US
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Telephone | 719-470-1715
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Fax |
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Provider Business Mailing Address
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Address Line | 1021 N. MARKET PLZ, STE.107, #531
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City | PUEBLO WEST
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State | CO
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Zip | 81007
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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 | OWNER/LICENSED PROFESSIONAL COUNSEL
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Name | ANGELA SILLAS-GREEN
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Credential | LPC
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Telephone | 719-580-3079
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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