Provider Demographics
NPI:1417510934
Name:CHANGES THERAPEUTIC SERVICES, LLC
Entity Type:Organization
Organization Name:CHANGES THERAPEUTIC SERVICES, LLC
Other - Org Name:CHANGES THERAPEUTICS SERVICES, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:314-368-2409
Mailing Address - Street 1:523 SAPPHIRE DR
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-1889
Mailing Address - Country:US
Mailing Address - Phone:314-368-2409
Mailing Address - Fax:314-442-4139
Practice Address - Street 1:12 FEE FEE RD
Practice Address - Street 2:
Practice Address - City:MARYLAND HEIGHTS
Practice Address - State:MO
Practice Address - Zip Code:63043-2729
Practice Address - Country:US
Practice Address - Phone:314-368-8920
Practice Address - Fax:314-442-4139
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHANGES THERAPEUTICS SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-04-19
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Single Specialty