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General NPI Number Information
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NPI Number | 1548625080
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Entity Type | Organization
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Legal Business Name | THE CHANGE STUDIO
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Dates
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Enumeration Date | 12/29/2015
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Last Update Date | 12/29/2015
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Provider Practice Location Address
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Address Line | 959 LAKE DR SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49506-1447
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Country | US
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Telephone | 616-259-5033
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Fax | 616-452-1024
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Provider Business Mailing Address
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Address Line | 959 LAKE DR SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49506-1447
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Country | US
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Telephone | 616-259-5033
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Fax | 616-452-1024
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | MS. DANA PATRICIA PRICE
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Credential | MA, LPC
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Telephone | 616-259-5033
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6401010358
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License Number State | MI
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