Provider Demographics
NPI:1437468725
Name:CENTER 4 CHANGE, L.L.C.
Entity Type:Organization
Organization Name:CENTER 4 CHANGE, L.L.C.
Other - Org Name:CENTER 4 CHANGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:J
Authorized Official - Last Name:COUNTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MED, LPC
Authorized Official - Phone:918-694-9677
Mailing Address - Street 1:111 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-5363
Mailing Address - Country:US
Mailing Address - Phone:918-694-9677
Mailing Address - Fax:918-423-5255
Practice Address - Street 1:111 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-5363
Practice Address - Country:US
Practice Address - Phone:918-694-9677
Practice Address - Fax:918-423-5255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-04
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4163101YP2500X
OK133823171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No171W00000XOther Service ProvidersContractorGroup - Multi-Specialty