Provider Demographics
NPI:1114260486
Name:CHANGES BEHAVIORAL HEALTH, LLC
Entity Type:Organization
Organization Name:CHANGES BEHAVIORAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:DICKSON
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:901-570-0556
Mailing Address - Street 1:204 MISSISSIPPI ST S
Mailing Address - Street 2:
Mailing Address - City:WYNNE
Mailing Address - State:AR
Mailing Address - Zip Code:72396-3025
Mailing Address - Country:US
Mailing Address - Phone:870-208-8499
Mailing Address - Fax:
Practice Address - Street 1:204 MISSISSIPPI ST S
Practice Address - Street 2:
Practice Address - City:WYNNE
Practice Address - State:AR
Practice Address - Zip Code:72396-3025
Practice Address - Country:US
Practice Address - Phone:870-208-8499
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-04
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR5606C251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health