Provider Demographics
NPI:1427803915
Name:MOUNTAIN OF CHANGE COUNSELING AND PSYCHOLOGICAL SERVICES PLLC
Entity type:Organization
Organization Name:MOUNTAIN OF CHANGE COUNSELING AND PSYCHOLOGICAL SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EVETTE
Authorized Official - Middle Name:AKUA
Authorized Official - Last Name:ADDAI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:217-520-6337
Mailing Address - Street 1:2027 W DIVISION ST # 130
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-9024
Mailing Address - Country:US
Mailing Address - Phone:312-219-4430
Mailing Address - Fax:
Practice Address - Street 1:661 W LAKE ST STE 2S
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60661-1034
Practice Address - Country:US
Practice Address - Phone:312-219-4430
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-18
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health