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General NPI Number Information
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NPI Number | 1255473641
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Entity Type | Organization
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Legal Business Name | CHANGE INC.
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 05/26/2020
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Provider Practice Location Address
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Address Line | 381 ROBIE ST E
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City | SAINT PAUL
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State | MN
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Zip | 55107-2415
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Country | US
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Telephone | 651-222-0757
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Fax |
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Provider Business Mailing Address
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Address Line | 381 ROBIE ST E
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City | SAINT PAUL
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State | MN
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Zip | 55107-2415
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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 | EXECUTIVE DIRECTOR
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Name | JODY NELSON
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Credential | EDD, LMFT
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Telephone | 651-222-0757
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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 |
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License Number State |
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