Organization
CONSULT 4 CHANGE LLC
Active
Organization
CONSULT 4 CHANGE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LAJUANA E MITCHELL MA (LPC)
(313) 590-5253
Entity
Organization
Contact information
Practice address
4802 E RAY RD SUITE 23-266, PHOENIX, AZ 85044-0620
(602) 620-5507
(602) 491-2677
Mailing address
4802 E RAY RD SUITE 23-266, PHOENIX, AZ 85044
(313) 590-5253
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
LPC16755
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
277387
—
AZ
01
—
L21933971
ENTITY ID
AZ
Enumeration date
03/08/2018
Last updated
03/30/2021
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