Provider Demographics
NPI:1528601069
Name:BEHAVIOR CHANGE, LLC
Entity Type:Organization
Organization Name:BEHAVIOR CHANGE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SHAKIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-330-7611
Mailing Address - Street 1:403 SW 103RD AVE APT 304
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33025-1881
Mailing Address - Country:US
Mailing Address - Phone:954-330-7611
Mailing Address - Fax:
Practice Address - Street 1:403 SW 103RD AVE APT 304
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33025-1881
Practice Address - Country:US
Practice Address - Phone:954-330-7611
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-28
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty