Provider Demographics
NPI:1164083515
Name:THE CENTER FOR CHANGE LLC
Entity Type:Organization
Organization Name:THE CENTER FOR CHANGE LLC
Other - Org Name:CENTER FOR CHANGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REPRESENTATIVE
Authorized Official - Prefix:
Authorized Official - First Name:MORGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-368-2380
Mailing Address - Street 1:4535 W RUSSELL RD STE 15
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-2258
Mailing Address - Country:US
Mailing Address - Phone:702-368-2380
Mailing Address - Fax:702-368-2316
Practice Address - Street 1:4535 W RUSSELL RD STE 15
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-2258
Practice Address - Country:US
Practice Address - Phone:702-368-2380
Practice Address - Fax:702-368-2316
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE CENTER FOR CHANGE LLC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-06-26
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty