Provider Demographics
NPI:1083198113
Name:CHANGES RECOVERY COUNSELING
Entity Type:Organization
Organization Name:CHANGES RECOVERY COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JACLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:SUTTON RANGEL
Authorized Official - Suffix:
Authorized Official - Credentials:CADC
Authorized Official - Phone:775-525-7300
Mailing Address - Street 1:PO BOX 117
Mailing Address - Street 2:
Mailing Address - City:PAHRUMP
Mailing Address - State:NV
Mailing Address - Zip Code:89041-0117
Mailing Address - Country:US
Mailing Address - Phone:775-525-7300
Mailing Address - Fax:
Practice Address - Street 1:2220 NEVADA WEST BLVD STE 2
Practice Address - Street 2:
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89048-5870
Practice Address - Country:US
Practice Address - Phone:775-525-7300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-25
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilityGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder