Provider Demographics
NPI:1144802521
Name:CHANGING PHASES, LLC
Entity Type:Organization
Organization Name:CHANGING PHASES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:SCHLOER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:224-421-6235
Mailing Address - Street 1:142 HAWLEY ST STE 1
Mailing Address - Street 2:
Mailing Address - City:GRAYSLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60030-3653
Mailing Address - Country:US
Mailing Address - Phone:224-421-6235
Mailing Address - Fax:630-349-8131
Practice Address - Street 1:142 HAWLEY ST STE 1
Practice Address - Street 2:
Practice Address - City:GRAYSLAKE
Practice Address - State:IL
Practice Address - Zip Code:60030-3653
Practice Address - Country:US
Practice Address - Phone:224-421-6235
Practice Address - Fax:630-349-8131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-25
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty