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General NPI Number Information
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NPI Number | 1417304320
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Entity Type | Organization
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Legal Business Name | PREPARE TO CHANGE, INC.
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Dates
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Enumeration Date | 05/20/2016
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Last Update Date | 01/29/2017
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Provider Practice Location Address
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Address Line | 9309 E COMMERCE DR STE 2
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City | CHURUBUSCO
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State | IN
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Zip | 46723-9557
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Country | US
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Telephone | 260-222-8288
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Fax |
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Provider Business Mailing Address
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Address Line | 5361 N 700 E
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City | CHURUBUSCO
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State | IN
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Zip | 46723-9323
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Country | US
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Telephone | 949-275-6047
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | DENISE M KUHN
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Credential |
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Telephone | 949-275-6047
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 20042828A
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License Number State | IN
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