Provider Demographics
NPI:1275411258
Name:THE CHANGE AGENCY
Entity type:Organization
Organization Name:THE CHANGE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISRATION
Authorized Official - Prefix:
Authorized Official - First Name:JASMYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:LOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-634-0195
Mailing Address - Street 1:2400 W STROOP RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45439-2041
Mailing Address - Country:US
Mailing Address - Phone:614-634-0195
Mailing Address - Fax:937-701-6901
Practice Address - Street 1:2400 W STROOP RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45439-2041
Practice Address - Country:US
Practice Address - Phone:614-634-0195
Practice Address - Fax:937-701-6901
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE CHANGE AGENCY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-08-26
Last Update Date:2025-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health