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General NPI Number Information
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NPI Number | 1821653239
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Entity Type | Organization
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Legal Business Name | THERAPEUTIC CHANGE PLLC
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Dates
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Enumeration Date | 05/01/2019
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Last Update Date | 05/01/2019
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Provider Practice Location Address
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Address Line | 1314 KAUFFMAN AVE
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City | VANCOUVER
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State | WA
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Zip | 98660-2725
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Country | US
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Telephone | 360-602-1477
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Fax | 360-334-5508
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Provider Business Mailing Address
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Address Line | 1314 KAUFFMAN AVE
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City | VANCOUVER
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State | WA
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Zip | 98660-2725
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Country | US
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Telephone | 360-602-1477
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Fax | 360-334-5508
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Authorized Official
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Title or Position | OWNER/ CLINICIAN
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Name | SUMMER LYN BROWN
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Credential | M.S.
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Telephone | 360-602-1477
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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Taxonomy #3
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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Taxonomy #4
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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