Organization
THERAPEUTIC LIFE CHANGES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TAMARA JO ANDERSON LICSW (PRESIDENT)
(701) 483-5259
Entity
Organization
Contact information
Practice address
634 9TH AVE W, DICKINSON, ND 58601-4745
(701) 483-5259
(701) 483-5259
Mailing address
634 9TH AVE W, DICKINSON, ND 58601-4745
(701) 483-5259
(701) 483-5259
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
3000
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
19242
—
ND
Enumeration date
01/04/2009
Last updated
01/04/2009
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