Provider Demographics
NPI:1851835722
Name:CHANGEPOINT, INC
Entity Type:Organization
Organization Name:CHANGEPOINT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUBSTANCE USE DISORDER COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:HERNANDEZ
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:CADCI
Authorized Official - Phone:503-352-8261
Mailing Address - Street 1:1700 NW PLACE
Mailing Address - Street 2:SUITE 240
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006
Mailing Address - Country:US
Mailing Address - Phone:503-350-2758
Mailing Address - Fax:503-350-1790
Practice Address - Street 1:1700 NW 167TH PLACE
Practice Address - Street 2:SUITE 240
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006
Practice Address - Country:US
Practice Address - Phone:503-350-2758
Practice Address - Fax:503-350-1790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-13
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR15-03-12261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder