Organization · Type 2 NPI

Active Change Center, LLC

Professional Counselor · Meridian, ID

NPI number 1497028161 Active

Practice location

2498 N Stokesberry Pl., Suite 180
Meridian, ID 83646

Call (208) 403-7488 Map

Fax (208) 529-1960

Mailing address

P.o. Box 409
Meridian, ID 83680-0409

Specialties and licenses

TaxonomyCodeLicense
Mental Health Counselor 101YM0800XNone listed
Professional Counselor 101YP2500XLCPC206 (ID)
Professional Counselor Primary 101YP2500XNone listed

Professional Counselor: Definition to come...

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About NPI 1497028161

Active Change Center, LLC's National Provider Identifier is 1497028161, issued on Feb 10, 2012. The primary taxonomy on file is Professional Counselor (101YP2500X), and the practice location is in Meridian, ID. The record was last updated on Jul 12, 2022.