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General NPI Number Information
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NPI Number | 1457406613
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Entity Type | Organization
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Legal Business Name | COURAGE TO CHANGE, INC.
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Dates
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Enumeration Date | 01/25/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 474 BARBOURVILLE RD SUITE 2
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City | LONDON
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State | KY
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Zip | 40744-9302
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Country | US
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Telephone | 606-877-9008
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Fax | 606-877-1785
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Provider Business Mailing Address
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Address Line | 474 BARBOURVILLE RD SUITE 2
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City | LONDON
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State | KY
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Zip | 40744-9302
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Country | US
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Telephone | 606-877-9008
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Fax | 606-877-1785
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR OWNER
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Name | MR. DAVID T TIPTON
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Credential | LPC
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Telephone | 606-877-9008
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | 3300106600
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License Number State | KY
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