Organization
TIME TO CHANGE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALLEN JEROME JOHNSON MA LADC (CEO)
(952) 484-5401
Entity
Organization
Contact information
Practice address
8609 LYNDALE AVE S, #110, BLOOMINGTON, MN 55420-2754
(952) 358-1009
Mailing address
8609 LYNDALE AVE S, #110, #214, #215, BLOOMINGTON, MN 55420-2754
(952) 358-1009
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
1076645-1-CDT
MN
Other
Enumeration date
03/07/2015
Last updated
03/07/2015
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