MEDICARE: CHANGING DYNAMICS LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101Y00000X	Counselor
2	101YP2500X	Professional Counselor
3	101YM0800X	Mental Health Counselor
4	101YS0200X	School Counselor
5	106S00000X	Behavior Technician
6	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1861238792
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHANGING DYNAMICS LLC

Provider Business Mailing Address
First Line	:	4035 N ELMHURST RD
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53216-1729
Country	:	US
Telephone Number	:	414-502-8880
Fax Number	:	877-940-3288

Provider Business Practice Location Address
First Line	:	4035 N ELMHURST RD
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53216-1729
Country	:	US
Telephone Number	:	414-502-8880
Fax Number	:	877-940-3288

Authorized Official
Title or Position	:	OWNER
Name	:	NATALIE D ANDERSON
Credential	:	MS, LMFT
Telephone Number	:	414-502-8880

Provider Enumeration Date	:	07/01/2024
Last Update Date	:	01/05/2026

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Directions to “CHANGING DYNAMICS LLC ” Practice Location

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