Active Change Center, LLC

NPI #1497028161 in Meridian, Idaho

Provider Information

NPI Number: 1497028161
Entity Type: Organization
Organization Name: Active Change Center, LLC
Primary Specialty: Counselor - Mental Health
Enumeration Date: Feb 10, 2012
Last Updated: Jul 12, 2022

Practice Location

Address: 2498 N STOKESBERRY PL.
Address 2: SUITE 180
City: Meridian
State: Idaho
ZIP Code: 83646
Phone: (208) 403-7488

Authorized Official

Name: MR. DANNY LEE RASCO
Title: BILLING AGENT
Phone: (208) 201-9513

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Counselor - Mental Health — Mental Health	101YM0800X	Primary
Counselor - Professional — Professional	101YP2500X

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