MEDICARE: MEANINGFUL CHANGE: CLINICAL & CONSULTATION PSYCHOLOGY, 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	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1881292076
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEANINGFUL CHANGE: CLINICAL & CONSULTATION PSYCHOLOGY, PLLC

Provider Business Mailing Address
First Line	:	1414 W HIGH ST STE A
Second Line	:
City	:	MOUNT PLEASANT
State	:	MI
Zip	:	48858-3065
Country	:	US
Telephone Number	:	989-824-6565
Fax Number	:	833-647-2020

Provider Business Practice Location Address
First Line	:	1414 W HIGH ST STE A
Second Line	:
City	:	MOUNT PLEASANT
State	:	MI
Zip	:	48858-3065
Country	:	US
Telephone Number	:	989-824-6565
Fax Number	:	833-647-2020

Authorized Official
Title or Position	:	DIRECTOR/OWNER
Name	:	DR. DAHAM RAUL SOL
Credential	:	PH.D, LP
Telephone Number	:	989-824-6565

Provider Enumeration Date	:	10/11/2020
Last Update Date	:	10/18/2025

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