Provider Demographics
NPI:1851117733
Name:RADICAL CHANGE, PLLC
Entity type:Organization
Organization Name:RADICAL CHANGE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANNO
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHEER
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:808-315-9311
Mailing Address - Street 1:PO BOX 1121
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-0213
Mailing Address - Country:US
Mailing Address - Phone:808-315-9311
Mailing Address - Fax:
Practice Address - Street 1:518 E 7TH ST
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-6215
Practice Address - Country:US
Practice Address - Phone:808-315-9311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty