Provider Demographics
NPI:1992556377
Name:WAVES OF CHANGE COUNSELING MT
Entity type:Organization
Organization Name:WAVES OF CHANGE COUNSELING MT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:ARCAND
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, LCSW
Authorized Official - Phone:763-226-8206
Mailing Address - Street 1:10972 STELLA BLUE DR
Mailing Address - Street 2:
Mailing Address - City:LOLO
Mailing Address - State:MT
Mailing Address - Zip Code:59847-8463
Mailing Address - Country:US
Mailing Address - Phone:763-226-8206
Mailing Address - Fax:
Practice Address - Street 1:1008 SOUTH AVE W
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-7948
Practice Address - Country:US
Practice Address - Phone:406-426-3642
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty