MEDICARE: THE POWER OF CHANGE 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
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	2944	WI
2	101YP2500X	Professional Counselor	2944	WI
3	291U00000X	Clinical Medical Laboratory	2944	WI
4	101YM0800X	Mental Health Counselor	2944	WI
5	106H00000X	Marriage & Family Therapist	2944	WI
6	103TP2701X	Group Psychotherapy Psychologist	2944	WI
7	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1730477688
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE POWER OF CHANGE LLC

Provider Business Mailing Address
First Line	:	2821 N VEL R PHILLIPS AVE STE 131
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53212-2370
Country	:	US
Telephone Number	:	414-374-8787
Fax Number	:	414-374-8181

Provider Business Practice Location Address
First Line	:	2821 N VEL R PHILLIPS AVE STE 131
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53212-2370
Country	:	US
Telephone Number	:	414-374-8787
Fax Number	:	414-374-8181

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	DR. LISA A ADAMS-QUALLS
Credential	:	PHD, SAC
Telephone Number	:	414-374-8787

Provider Enumeration Date	:	07/13/2011
Last Update Date	:	01/12/2026

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Directions to “THE POWER OF CHANGE LLC ” Practice Location

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