Provider Demographics
NPI:1629675889
Name:COLLABORATIVE CHANGE THERAPY SERVICES
Entity Type:Organization
Organization Name:COLLABORATIVE CHANGE THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HANNAH
Authorized Official - Middle Name:RACHEL
Authorized Official - Last Name:HYDE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:734-203-0020
Mailing Address - Street 1:302 N HURON ST
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-2947
Mailing Address - Country:US
Mailing Address - Phone:734-203-0020
Mailing Address - Fax:734-773-1611
Practice Address - Street 1:302 N HURON ST
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-2947
Practice Address - Country:US
Practice Address - Phone:734-203-0020
Practice Address - Fax:734-773-1611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-01
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty