Provider Demographics
NPI:1619461464
Name:A CHANGE IN TRAJECTORY, LLC
Entity Type:Organization
Organization Name:A CHANGE IN TRAJECTORY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, LEAD BCBA
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:TURACK
Authorized Official - Suffix:
Authorized Official - Credentials:MA, BCBA
Authorized Official - Phone:414-202-1035
Mailing Address - Street 1:1844 MONICA DRIVE
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33763-4128
Mailing Address - Country:US
Mailing Address - Phone:414-202-1035
Mailing Address - Fax:
Practice Address - Street 1:1844 MONICA DR
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33763-4128
Practice Address - Country:US
Practice Address - Phone:414-202-1035
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-15
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty