Provider Demographics
NPI:1093006017
Name:CHANGE BEHAVIORAL HEALTH, INC
Entity Type:Organization
Organization Name:CHANGE BEHAVIORAL HEALTH, INC
Other - Org Name:CHANGE BEHAVIORAL HEALTH, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTOVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:HARRINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:BA, MA, MFT
Authorized Official - Phone:319-233-0323
Mailing Address - Street 1:2307 FALLS AVENUE SUITE 4
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50701-5700
Mailing Address - Country:US
Mailing Address - Phone:319-233-0323
Mailing Address - Fax:319-233-5923
Practice Address - Street 1:501 SYCAMORE ST STE 623
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50703-4651
Practice Address - Country:US
Practice Address - Phone:319-233-0323
Practice Address - Fax:319-233-5923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-25
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health