Provider Demographics
NPI:1720372451
Name:C.H.A.N.G.E.S. YOUTH SERVICES
Entity Type:Organization
Organization Name:C.H.A.N.G.E.S. YOUTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MOHAMMED
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:407-276-3069
Mailing Address - Street 1:1067 COVINGTON ST
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-7034
Mailing Address - Country:US
Mailing Address - Phone:407-276-3069
Mailing Address - Fax:
Practice Address - Street 1:1067 COVINGTON ST
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-7034
Practice Address - Country:US
Practice Address - Phone:407-276-3069
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-28
Last Update Date:2011-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health