# CHANGING STRIDES THERAPY LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1487001400
- **Authorized official:** STACY LOUISE GUSTAFSON LPCC (COUNSELOR)
- **Authorized official phone:** (218) 833-7636

## Contact information

- **Practice address:** 10010 STRAWBERRY LAKE RD, PEQUOT LAKES, MN 56472-2291
- **Practice address phone:** (218) 833-7636
- **Practice address fax:** (218) 543-4394
- **Mailing address:** PO BOX 625, CROSSLAKE, MN 56442-0625
- **Mailing address phone:** (218) 833-7636
- **Mailing address fax:** (218) 543-4394

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YM0800X | Mental Health Counselor | CC01066 | MN | Yes |

## Other

- **Enumeration date:** 05/19/2016
- **Last updated:** 12/04/2024