Organization
CENTER FOR CHANGE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESSICA YOUNG LPC (OWNER)
(262) 607-2770
Entity
Organization
Contact information
Practice address
129 KENOSHA ST, WALWORTH, WI 53184
(262) 607-2770
Mailing address
PO BOX 252, WALWORTH, WI 53184-0252
(262) 607-2770
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
5479-125
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100054731
—
WI
Enumeration date
04/10/2017
Last updated
06/13/2024
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