Provider Demographics
NPI:1659744035
Name:GUIDING CHANGE PSYCHOTHERAPY LLC
Entity Type:Organization
Organization Name:GUIDING CHANGE PSYCHOTHERAPY LLC
Other - Org Name:GUIDING CHANGE THERAPY LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:LCSW
Authorized Official - Phone:908-581-5574
Mailing Address - Street 1:PO BOX 52284
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-0319
Mailing Address - Country:US
Mailing Address - Phone:941-342-7390
Mailing Address - Fax:
Practice Address - Street 1:5049 RINGWOOD MDW
Practice Address - Street 2:SUITE A
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34235-2035
Practice Address - Country:US
Practice Address - Phone:941-342-7390
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-05
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW128411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty