Center for Change, LLC
Organization Active NPI Mental Health Counselor · Walworth, WI
NPI 1720511330 · NPPES record last updated Jun 13, 2024
Key facts
- NPI
- 1720511330
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Mental Health Counselor 101YM0800X
- License
- 5479-125 (WI)
- Legal business name
- CENTER FOR CHANGE, LLC
- Practice address
- 129 Kenosha St
Walworth, WI 53184 - Phone
- (262) 607-2770
- NPI assigned
- Apr 10, 2017
- Organization subpart
- No
Authorized official
- Name
- Jessica Young, LPC
- Title
- Owner
- Phone
- (262) 607-2770
Practitioners 6
-
Jessica Young, LPC, CMHIMP
-
Veronique M Wolf, MS, LPC, CSAC
-
Denise Millet, MS, LPC, LMFT-IT
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20240304001640 | WI | Part B Supplier - Clinic/Group Practice | 9830534551 |
Receives reassigned benefits from 3 practitioners Practice locations: Walworth, WI |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor |
101YM0800X | 5479-125 | WI | Yes |
Addresses
Primary practice location
129 Kenosha St
Walworth, WI 53184
Mailing address
PO Box 252
Walworth, WI 53184-0252
Phone (262) 607-2770
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100054731 | Medicaid | WI |
Other providers in Walworth, WI
- Aurora Medical Group, Inc.
- Aurora Pharmacy Inc
- BBGH Partnership
- Thomas A Beci
- Big Foot Union High School
- Stephen Andrew Cole
- Bernice Lorraine Elliott
- Mary E. Frazier
- Hollyanne George
- Robert M Gerson
All providers in Walworth, WI · Mental Health Counselor in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 13, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.