Provider Demographics
NPI:1356075576
Name:BE THE CHANGE THERAPEUTIC SERVICES LLC
Entity Type:Organization
Organization Name:BE THE CHANGE THERAPEUTIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LISW-S
Authorized Official - Phone:740-262-8710
Mailing Address - Street 1:1601-1 N MAIN ST UNIT 3159
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32206-7707
Mailing Address - Country:US
Mailing Address - Phone:941-315-8433
Mailing Address - Fax:
Practice Address - Street 1:1601-1 N MAIN ST UNIT 3159
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32206-7707
Practice Address - Country:US
Practice Address - Phone:941-315-8433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-13
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)