Provider Demographics
NPI:1508581596
Name:TRUE COLORS TANGIBLE CHANGE BEHAVIORAL HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:TRUE COLORS TANGIBLE CHANGE BEHAVIORAL HEALTH SERVICES LLC
Other - Org Name:TRUE COLORS . TANGIBLE CHANGE BEHAVIORAL HEALTH SERVICES LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FOUNDER/ CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:KANIYA
Authorized Official - Middle Name:C
Authorized Official - Last Name:MURRAY
Authorized Official - Suffix:
Authorized Official - Credentials:QMHS, JSOCC
Authorized Official - Phone:513-335-7556
Mailing Address - Street 1:1325 E KEMPER RD STE 211
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:OH
Mailing Address - Zip Code:45246-3921
Mailing Address - Country:US
Mailing Address - Phone:513-726-8354
Mailing Address - Fax:
Practice Address - Street 1:1325 E KEMPER RD STE 211
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:OH
Practice Address - Zip Code:45246-3921
Practice Address - Country:US
Practice Address - Phone:513-726-8354
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-11
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1255974432Medicaid