Provider Demographics
NPI:1487428496
Name:WINDS OF CHANGE MARRIAGE AND FAMILY COUNSELING CENTER, INC
Entity type:Organization
Organization Name:WINDS OF CHANGE MARRIAGE AND FAMILY COUNSELING CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNA-BRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ENGELKE
Authorized Official - Suffix:
Authorized Official - Credentials:ASW
Authorized Official - Phone:805-952-2230
Mailing Address - Street 1:PO BOX 562
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMOS
Mailing Address - State:CA
Mailing Address - Zip Code:93440-0562
Mailing Address - Country:US
Mailing Address - Phone:805-350-1936
Mailing Address - Fax:
Practice Address - Street 1:115 E HICKORY AVE
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-7274
Practice Address - Country:US
Practice Address - Phone:805-350-1936
Practice Address - Fax:805-430-8151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-09
Last Update Date:2023-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty