Provider Demographics
NPI:1659517472
Name:CHANGE YOUR MIND, LLC
Entity Type:Organization
Organization Name:CHANGE YOUR MIND, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:FAYE
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:SCHOLZ
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW, LCADC
Authorized Official - Phone:732-775-1381
Mailing Address - Street 1:113 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:OCEAN GROVE
Mailing Address - State:NJ
Mailing Address - Zip Code:07756-1101
Mailing Address - Country:US
Mailing Address - Phone:732-775-1381
Mailing Address - Fax:
Practice Address - Street 1:210 W FRONT ST STE 208
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-1171
Practice Address - Country:US
Practice Address - Phone:732-996-4829
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-29
Last Update Date:2008-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC052317001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty