Provider Demographics
NPI:1700054368
Name:THE CENTER 4 CHANGE, LLC
Entity Type:Organization
Organization Name:THE CENTER 4 CHANGE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:BACHER
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMHC
Authorized Official - Phone:727-519-0707
Mailing Address - Street 1:13787 BELCHER RD S
Mailing Address - Street 2:SUITE 340
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33771-4065
Mailing Address - Country:US
Mailing Address - Phone:727-519-0707
Mailing Address - Fax:727-523-9102
Practice Address - Street 1:13787 BELCHER RD S
Practice Address - Street 2:SUITE 340
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771-4065
Practice Address - Country:US
Practice Address - Phone:727-519-0707
Practice Address - Fax:727-523-9102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-18
Last Update Date:2008-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0002835251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health