Change by Coniah Family Counseling, a Professional Corporation

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

LMFT48746 Issued in CA

Legal business name

CHANGE BY CONIAH FAMILY COUNSELING, A PROFESSIONAL CORPORATION

Practice address

2376 Maritime Dr Ste 200
Elk Grove, CA 95758-3640

Phone

(916) 531-5647

Fax

(916) 405-3470

NPI assigned

Aug 14, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Carol Letresse Wallace, LMFTNPI 1912022492

Title

Ceo

Phone

(916) 531-5647

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Carol L Wallace, MA, LMFT

  • Marriage & Family Therapist
  • Elk Grove, CA
  • NPI 1912022492
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1534204800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1534204800000",
    "number": "1467931022",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2376 MARITIME DR STE 200",
            "city": "ELK GROVE",
            "state": "CA",
            "postal_code": "957583640",
            "telephone_number": "916-531-5647",
            "fax_number": "916-531-5647"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2376 MARITIME DR STE 200",
            "city": "ELK GROVE",
            "state": "CA",
            "postal_code": "957583640",
            "telephone_number": "916-531-5647",
            "fax_number": "916-405-3470"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHANGE BY CONIAH FAMILY COUNSELING, A PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-14",
        "last_updated": "2018-08-14",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "CAROL",
        "authorized_official_middle_name": "LETRESSE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "916-531-5647",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LMFT"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "LMFT48746",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hannah Chang
• Kaisa Chang
• Koua Chang
• Samantha A. Chang, DO
• Sean Salguero Chang
• Jeffery C Chantry, DDS
• Leliana Nguyen Chao
• Chaos to Calm LLC (Karly Jo McComas)
• Adrianna Marie Chaparro, PSYD
• Freda Charity

• Marriage & Family Therapist in Elk Grove, CA
• Providers in Elk Grove, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.