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General NPI Number Information
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NPI Number | 1316638893
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Entity Type | Organization
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Legal Business Name | CHANGE TO EVOLVE LLC
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Dates
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Enumeration Date | 05/16/2023
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Last Update Date | 05/16/2023
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Provider Practice Location Address
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Address Line | 2 PARK AVE FL 20
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City | NEW YORK
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State | NY
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Zip | 10016-9306
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Country | US
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Telephone | 917-940-6607
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Fax |
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Provider Business Mailing Address
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Address Line | 2 PARK AVE FL 20
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City | NEW YORK
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State | NY
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Zip | 10016-9306
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Country | US
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Telephone | 917-940-6607
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOHN SAUNDERS
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Credential |
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Telephone | 917-940-6607
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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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