MEDICARE: SEASONS OF CHANGE THERAPY, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1174457261
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEASONS OF CHANGE THERAPY, PLLC

Provider Business Mailing Address
First Line	:	2106 MOUNT VERNON ST
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-2820
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2106 MOUNT VERNON ST
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-2820
Country	:	US
Telephone Number	:	719-286-0070
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JACQUELINE SUSAN LEINDECKER
Credential	:	MA, LPC, LAC
Telephone Number	:	303-880-7256

Provider Enumeration Date	:	06/11/2026
Last Update Date	:	06/11/2026

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