| Ichoose Change, Llc | |
|
1600 Malabar Rd J-119 Melbourne FL 32935-1408 | |
| (321) 205-7790 | |
| Not Available |
| Full Name | Ichoose Change, Llc |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 1600 Malabar Rd, Melbourne, Florida |
| Authorized Official Name and Position | Roselyn L Burnett (CEO/ THERAPIST) |
| Authorized Official Contact | 3213397736 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ichoose Change, Llc 570 Malabar Rd Sw Apt 102 Palm Bay FL 32907-3312 Ph: (321) 339-7736 | Ichoose Change, Llc 1600 Malabar Rd J-119 Melbourne FL 32935-1408 Ph: (321) 205-7790 |
| NPI Number | 1528689122 |
|---|---|
| Provider Enumeration Date | 05/05/2020 |
| Last Update Date | 05/05/2020 |
| Certification Date | 05/05/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528689122 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
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