Provider Demographics
NPI:1518265958
Name:POSITIVE CHANGE
Entity Type:Organization
Organization Name:POSITIVE CHANGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:KATHERINE
Authorized Official - Last Name:WHITT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:719-578-9730
Mailing Address - Street 1:1120 N CIRCLE DR
Mailing Address - Street 2:#11
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-3156
Mailing Address - Country:US
Mailing Address - Phone:719-578-9730
Mailing Address - Fax:729-473-7759
Practice Address - Street 1:1120 N CIRCLE DR
Practice Address - Street 2:#11
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-3156
Practice Address - Country:US
Practice Address - Phone:719-578-9730
Practice Address - Fax:729-473-7759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-09
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO992160101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO532836Medicaid
CO532836Medicaid