Provider Demographics
NPI:1093017055
Name:WAYCHANGERS SERVICES LLC
Entity Type:Organization
Organization Name:WAYCHANGERS SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CLAIBORNE
Authorized Official - Middle Name:J
Authorized Official - Last Name:CHRISTIAN
Authorized Official - Suffix:III
Authorized Official - Credentials:LMHC
Authorized Official - Phone:813-731-1795
Mailing Address - Street 1:3210 THACKERY WAY
Mailing Address - Street 2:
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33566
Mailing Address - Country:US
Mailing Address - Phone:813-731-1975
Mailing Address - Fax:866-472-9754
Practice Address - Street 1:710 OAK FIELD DR
Practice Address - Street 2:SUITE 153
Practice Address - City:BRENDON
Practice Address - State:FL
Practice Address - Zip Code:33511
Practice Address - Country:US
Practice Address - Phone:866-472-7075
Practice Address - Fax:866-472-9754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-24
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
FLMH9398251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL766129100Medicaid