| Catalyst For Change Counseling Llc | |
|
7703 Bowlander Way Fort Wayne IN 46835-9145 | |
| (260) 414-1127 | |
| Not Available |
| Full Name | Catalyst For Change Counseling Llc |
|---|---|
| Speciality | Counselor |
| Location | 7703 Bowlander Way, Fort Wayne, Indiana |
| Authorized Official Name and Position | Kelly L Kessens (SOLE MEMBER) |
| Authorized Official Contact | 2604141127 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Catalyst For Change Counseling Llc 7703 Bowlander Way Fort Wayne IN 46835-9145 Ph: (260) 414-1127 | Catalyst For Change Counseling Llc 7703 Bowlander Way Fort Wayne IN 46835-9145 Ph: (260) 414-1127 |
| NPI Number | 1023879038 |
|---|---|
| Provider Enumeration Date | 01/17/2024 |
| Last Update Date | 01/17/2024 |
| Certification Date | 01/17/2024 |
| Medicare PECOS PAC ID | 2961944491 |
|---|---|
| Medicare Enrollment ID | O20240611004449 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023879038 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Kelly L. Kessens |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1437399912 PECOS PAC ID: 8123279080 Enrollment ID: I20240611004499 |
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