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General NPI Number Information
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NPI Number | 1467917609
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Entity Type | Organization
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Legal Business Name | CHOICE 2 CHANGE THERAPY, INC.
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Dates
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Enumeration Date | 02/01/2019
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Last Update Date | 02/01/2019
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Provider Practice Location Address
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Address Line | 217 WISCONSIN AVE STE 114
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City | WAUKESHA
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State | WI
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Zip | 53186-4946
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Country | US
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Telephone | 414-301-1518
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Fax | 414-301-7498
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Provider Business Mailing Address
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Address Line | 217 WISCONSIN AVE STE 114
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City | WAUKESHA
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State | WI
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Zip | 53186-4946
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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
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Name | NICOLE FLANNERY
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Credential |
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Telephone | 414-301-1518
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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