Provider Demographics
NPI:1750457503
Name:CENTER FOR POSITIVE CHANGE, P.C.
Entity Type:Organization
Organization Name:CENTER FOR POSITIVE CHANGE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:A
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:847-529-0558
Mailing Address - Street 1:205 COMMERCE DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:GRAYSLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60030-1646
Mailing Address - Country:US
Mailing Address - Phone:847-529-0558
Mailing Address - Fax:
Practice Address - Street 1:205 COMMERCE DR
Practice Address - Street 2:SUITE C
Practice Address - City:GRAYSLAKE
Practice Address - State:IL
Practice Address - Zip Code:60030-1646
Practice Address - Country:US
Practice Address - Phone:847-529-0558
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-24
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
294100-000OtherMAGELLAN HEALTH SERVICES
256988OtherMANAGED HEALTH NETWORK
256988OtherMANAGED HEALTH NETWORK