Provider Demographics
NPI:1164130480
Name:PENNSYLVANIA CENTER FOR CHANGE LLC
Entity Type:Organization
Organization Name:PENNSYLVANIA CENTER FOR CHANGE LLC
Other - Org Name:PA CENTER FOR CHANGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:PARISH
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:412-612-2270
Mailing Address - Street 1:20399 ROUTE 19 STE 200
Mailing Address - Street 2:
Mailing Address - City:CRANBERRY TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:16066-6137
Mailing Address - Country:US
Mailing Address - Phone:412-302-7166
Mailing Address - Fax:
Practice Address - Street 1:20399 ROUTE 19 STE 200
Practice Address - Street 2:
Practice Address - City:CRANBERRY TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:16066-6137
Practice Address - Country:US
Practice Address - Phone:412-612-2270
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-07
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty