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General NPI Number Information
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NPI Number | 1912545047
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Entity Type | Organization
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Legal Business Name | WAVES OF CHANGE COUNSELING, LLC
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Dates
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Enumeration Date | 12/19/2019
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Last Update Date | 01/20/2020
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Provider Practice Location Address
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Address Line | 2 6TH AVE E
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City | POLSON
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State | MT
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Zip | 59860-2726
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Country | US
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Telephone | 406-450-8082
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 965
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City | POLSON
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State | MT
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Zip | 59860-0965
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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 | LCPC COUNSELOR
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Name | DANA HELLINGER
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Credential |
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Telephone | 406-450-8082
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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