| NPI | 1114630076 |
|---|---|
| Former Legal Business Name | AVENUES FOR CHANGE |
| Entity Type | Organization |
| Authorized Contact | KELLEY JOHNSON President 620-796-2206 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2023-01-05 |
| Last Update Date | 2024-04-14 |