Provider Demographics
NPI:1245588409
Name:CHANGING TREE WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:CHANGING TREE WELLNESS CENTER, LLC
Other - Org Name:AMERICA COUNSELING SERVICES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELLISA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LMHC,CAP
Authorized Official - Phone:863-261-8900
Mailing Address - Street 1:203 SE 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:OKEECHOBEE
Mailing Address - State:FL
Mailing Address - Zip Code:34974-4305
Mailing Address - Country:US
Mailing Address - Phone:863-261-8900
Mailing Address - Fax:863-279-1156
Practice Address - Street 1:203 SE 2ND AVE
Practice Address - Street 2:
Practice Address - City:OKEECHOBEE
Practice Address - State:FL
Practice Address - Zip Code:34974-4305
Practice Address - Country:US
Practice Address - Phone:863-261-8900
Practice Address - Fax:863-279-1156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-20
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH10761101YA0400X, 101YM0800X, 101YP2500X, 102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalystGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003835200Medicaid