Active Change Center, LLC
Organization Active NPI Professional Counselor · Meridian, ID
NPI 1497028161 · NPPES record last updated Jul 12, 2022
Key facts
- NPI
- 1497028161
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Professional Counselor 101YP2500X
- Legal business name
- ACTIVE CHANGE CENTER, LLC
- Practice address
- 2498 N Stokesberry PL.
Suite 180
Meridian, ID 83646 - Phone
- (208) 403-7488
- Fax
- (208) 529-1960
- NPI assigned
- Feb 10, 2012
- Organization subpart
- No
Authorized official
- Name
- Mr. Danny Lee Rasco
- Title
- Billing Agent
- Phone
- (208) 201-9513
Practitioners 1
-
Joann Koester, LCPC
National Provider Directory
Locations
901 Pier View Dr
Ste 204
Idaho Falls, ID 83402
2498 N Stokesberry Pl
Ste 180
Meridian, ID 83646
Phone (208) 403-7488
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor |
101YM0800X | |||
| Professional Counselor |
101YP2500X | LCPC206 | ID | |
| Professional Counselor |
101YP2500X | Yes |
Addresses
Primary practice location
2498 N Stokesberry PL.
Suite 180
Meridian, ID 83646
Mailing address
P.O. Box 409
Meridian, ID 83680-0409
Phone (208) 403-7488
Other names
- ACTIVE CHANGE CENTER
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All providers in Meridian, ID · Professional Counselor in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 12, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.