Organization
A CHANGE COUNSELING CENTER INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MELINDA J BROUSSARD (OFFICE MANAGER)
(253) 473-1844
Entity
Organization
Contact information
Practice address
4002 S M ST STE C, TACOMA, WA 98418-3800
(253) 473-1844
(253) 473-1839
Mailing address
4002 S M ST STE C, TACOMA, WA 98418-3800
(253) 473-1844
(253) 473-1839
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
CP00000521
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1328
PREMERA BLUE CROSS ID
WA
Enumeration date
09/20/2006
Last updated
08/22/2020
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