Provider Demographics
NPI:1548597438
Name:CENTER FOR THOUGHTFUL LASTING CHANGE INC
Entity Type:Organization
Organization Name:CENTER FOR THOUGHTFUL LASTING CHANGE INC
Other - Org Name:CENTER FOR THOUGHTFUL LASTING CHANGE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:G
Authorized Official - Last Name:CASPER
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D
Authorized Official - Phone:619-369-5050
Mailing Address - Street 1:PO BOX 421146
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92142
Mailing Address - Country:US
Mailing Address - Phone:619-369-5050
Mailing Address - Fax:877-485-5961
Practice Address - Street 1:9606 TIERRA GRANDE #201
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126
Practice Address - Country:US
Practice Address - Phone:619-369-5050
Practice Address - Fax:877-485-5961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-12
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20550103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty