Provider Demographics
NPI:1548625080
Name:THE CHANGE STUDIO
Entity type:Organization
Organization Name:THE CHANGE STUDIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:DANA
Authorized Official - Middle Name:PATRICIA
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:616-259-5033
Mailing Address - Street 1:959 LAKE DR SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-1447
Mailing Address - Country:US
Mailing Address - Phone:616-259-5033
Mailing Address - Fax:616-452-1024
Practice Address - Street 1:959 LAKE DR SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49506-1447
Practice Address - Country:US
Practice Address - Phone:616-259-5033
Practice Address - Fax:616-452-1024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-29
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401010358101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty