Provider Demographics
NPI:1508169756
Name:CENTER OF CHANGE, L.L.C.
Entity Type:Organization
Organization Name:CENTER OF CHANGE, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:L
Authorized Official - Last Name:MERIWEATHER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:417-888-0886
Mailing Address - Street 1:636 W REPUBLIC RD
Mailing Address - Street 2:C116
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-5818
Mailing Address - Country:US
Mailing Address - Phone:417-888-0886
Mailing Address - Fax:417-888-0846
Practice Address - Street 1:636 W REPUBLIC RD
Practice Address - Street 2:C116
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-5818
Practice Address - Country:US
Practice Address - Phone:417-888-0886
Practice Address - Fax:417-888-0846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-09
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOPY01872103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty