Provider Demographics
NPI:1518202100
Name:CHANGEPOINT INTEGRATED HEALTH
Entity Type:Organization
Organization Name:CHANGEPOINT INTEGRATED HEALTH
Other - Org Name:COMMUNITY COUNSELING CENTERS INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:OAKES
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:928-537-2951
Mailing Address - Street 1:1801 W DEUCE OF CLUBS
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SHOW LOW
Mailing Address - State:AZ
Mailing Address - Zip Code:85901-2705
Mailing Address - Country:US
Mailing Address - Phone:928-537-2951
Mailing Address - Fax:928-892-5828
Practice Address - Street 1:1801 W DEUCE OF CLUBS
Practice Address - Street 2:SUITE 100
Practice Address - City:SHOW LOW
Practice Address - State:AZ
Practice Address - Zip Code:85901-2705
Practice Address - Country:US
Practice Address - Phone:928-537-2951
Practice Address - Fax:928-892-5828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-07
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH140251S00000X
AZBH3321251S00000X
AZBH806251S00000X
AZBH4058251S00000X
AZSH4758283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ117138Medicaid
AZ003450Medicaid
AZ007460Medicaid
AZ740227Medicaid
AZ505143Medicaid
AZ108490Medicaid