Provider Demographics
NPI:1922505619
Name:CHANGES TO YOUTH AND FAMILY SERVICES, LLC
Entity Type:Organization
Organization Name:CHANGES TO YOUTH AND FAMILY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TAWANA
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE-PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-606-5335
Mailing Address - Street 1:2810 FREDDIE ST
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71107-4216
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1331 US HIGHWAY 80 E STE 205
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-5780
Practice Address - Country:US
Practice Address - Phone:318-734-7614
Practice Address - Fax:318-606-5671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-09
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health