Organization
ACTIVE CHANGE CENTER, LLC
Active
Other names
ACTIVE CHANGE CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DANNY LEE RASCO (BILLING AGENT)
(208) 201-9513
Entity
Organization
Contact information
Practice address
2498 N STOKESBERRY PL., SUITE 180, MERIDIAN, ID 83646
(208) 403-7488
(208) 529-1960
Mailing address
P.O. BOX 409, MERIDIAN, ID 83680-0409
(208) 403-7488
(208) 529-1960
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
LCPC206
ID
101YP2500X
Professional Counselor
Primary
—
—
Other
Enumeration date
02/10/2012
Last updated
07/12/2022
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