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General NPI Number Information
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NPI Number | 1508411869
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Entity Type | Organization
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Legal Business Name | POSITIVE CHANGES COUNSELING SERVICES LLC
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Dates
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Enumeration Date | 08/05/2019
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Last Update Date | 08/05/2019
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Provider Practice Location Address
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Address Line | 124 RUM RIVER DR N
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City | PRINCETON
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State | MN
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Zip | 55371-1617
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Country | US
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Telephone | 763-242-8518
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Fax |
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Provider Business Mailing Address
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Address Line | 124 RUM RIVER DR N
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City | PRINCETON
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State | MN
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Zip | 55371-1617
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Country | US
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Telephone | 763-242-8518
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Fax |
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Authorized Official
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Title or Position | BUSINESS ADMINISTRATOR
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Name | JENNIFER DUNCAN
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Credential | BA, MHP
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Telephone | 763-242-8518
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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