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General NPI Number Information
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NPI Number | 1992212328
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Entity Type | Organization
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Legal Business Name | CHANGING FORWARD, LLC
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Dates
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Enumeration Date | 01/08/2018
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Last Update Date | 01/08/2018
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Provider Practice Location Address
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Address Line | 1040 BAYVIEW DR STE 110
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City | FORT LAUDERDALE
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State | FL
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Zip | 33304-2532
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Country | US
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Telephone | 954-800-0818
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Fax | 954-800-0910
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Provider Business Mailing Address
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Address Line | 1040 BAYVIEW DR STE 110
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City | FORT LAUDERDALE
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State | FL
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Zip | 33304-2532
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Country | US
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Telephone | 954-800-0818
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Fax | 954-800-0910
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Authorized Official
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Title or Position | PRESIDENT, PSYCHOTHERAPIST
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Name | DR. AURELIA ETKA BICKLER
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Credential | PHD, LMFT
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Telephone | 954-684-6220
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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 | MT25589
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License Number State | FL
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