Provider Demographics
NPI:1215710819
Name:COURAGE TO CHANGE CORP
Entity type:Organization
Organization Name:COURAGE TO CHANGE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PBSS
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:T
Authorized Official - Last Name:TIPTON
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPCC
Authorized Official - Phone:606-224-8451
Mailing Address - Street 1:311 WALKER LN
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40744-9036
Mailing Address - Country:US
Mailing Address - Phone:606-224-8451
Mailing Address - Fax:
Practice Address - Street 1:2785 N MAIN ST STE 101B
Practice Address - Street 2:
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-5910
Practice Address - Country:US
Practice Address - Phone:606-224-8451
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-16
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental DisabilitiesGroup - Multi-Specialty