Provider Demographics
NPI:1376310995
Name:PHASES OF CHANGE INTERVENTIONS, INC
Entity Type:Organization
Organization Name:PHASES OF CHANGE INTERVENTIONS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNDER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDI
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:INDA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:918-852-0416
Mailing Address - Street 1:PO BOX 4318
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74159-0318
Mailing Address - Country:US
Mailing Address - Phone:918-852-0416
Mailing Address - Fax:
Practice Address - Street 1:5001 S 67TH EAST AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74145-5708
Practice Address - Country:US
Practice Address - Phone:918-852-0416
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty