| NPI | 1497028161 |
|---|---|
| Doing Business As | ACTIVE CHANGE CENTER |
| Entity Type | Organization |
| Authorized Contact | DANNY LEE RASCO Billing Agent 208-201-9513 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 101YP2500X Counselor Professional (Licence: ID LCPC206) | |
| Enumeration Date | 2012-02-10 |
| Last Update Date | 2022-07-12 |