| Center For Change, Llc | |
|
129 Kenosha St Walworth WI 53184 | |
| (262) 607-2770 | |
| Not Available |
| Full Name | Center For Change, Llc |
|---|---|
| Speciality | Counselor |
| Location | 129 Kenosha St, Walworth, Wisconsin |
| Authorized Official Name and Position | Jessica Young (OWNER) |
| Authorized Official Contact | 2626072770 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Center For Change, Llc Po Box 252 Walworth WI 53184-0252 Ph: (262) 607-2770 | Center For Change, Llc 129 Kenosha St Walworth WI 53184 Ph: (262) 607-2770 |
| NPI Number | 1720511330 |
|---|---|
| Provider Enumeration Date | 04/10/2017 |
| Last Update Date | 06/13/2024 |
| Certification Date | 06/06/2024 |
| Medicare PECOS PAC ID | 9830534551 |
|---|---|
| Medicare Enrollment ID | O20240304001640 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720511330 | NPI | - | NPPES |
| 100054731 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | 5479-125 (Wisconsin) | Primary |
| Provider Name | Jessica Nicole Young |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1902200108 PECOS PAC ID: 0749625465 Enrollment ID: I20240304001766 |
Lake Geneva Psychology, Inc. Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 630 Kenosha St, Walworth, WI 53184 Phone: 305-989-9030 |