Provider Demographics
NPI:1861238792
Name:CHANGING DYNAMICS LLC
Entity type:Organization
Organization Name:CHANGING DYNAMICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LMFT
Authorized Official - Phone:414-502-8880
Mailing Address - Street 1:4035 N ELMHURST RD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53216-1729
Mailing Address - Country:US
Mailing Address - Phone:414-502-8880
Mailing Address - Fax:877-940-3288
Practice Address - Street 1:4035 N ELMHURST RD
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-1729
Practice Address - Country:US
Practice Address - Phone:414-502-8880
Practice Address - Fax:877-940-3288
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHANGING DYNAMICS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchoolGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty