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NPI Code Detail

MEDICARE: INTEGRATED CHANGE COUNSELING LLC

MEDICARE: INTEGRATED CHANGE COUNSELING LLC
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
1251S00000XCommunity/Behavioral Health Agency

General Provider Information

NPI Number : 1225773427
Entity Type Code : Organization
Provider Name (Legal Business Name) : INTEGRATED CHANGE COUNSELING LLC
Provider Business Mailing Address
First Line : 3115 S GRAND BLVD STE 300
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63118-1046
Country : US
Telephone Number : 636-323-9829
Fax Number : 314-552-7051
Provider Business Practice Location Address
First Line : 3115 S GRAND BLVD STE 300
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63118-1046
Country : US
Telephone Number : 636-323-9829
Fax Number : 314-552-7051
Authorized Official
Title or Position : MANAGER
Name : MEGAN CHRISTINE JANUSHANIS
Credential : MA, LPC
Telephone Number : 636-323-9829
Provider Enumeration Date : 05/02/2022
Last Update Date : 06/08/2026

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Directions to “INTEGRATED CHANGE COUNSELING LLC ” Practice Location

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