Provider Demographics
NPI:1922648021
Name:CHANGING TIMES 2020 VISION LLC
Entity Type:Organization
Organization Name:CHANGING TIMES 2020 VISION LLC
Other - Org Name:CHANGING TIMES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF BILLING
Authorized Official - Prefix:
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:CLEMETSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-475-7713
Mailing Address - Street 1:2601 ANDERSON AVE STE 207
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-2809
Mailing Address - Country:US
Mailing Address - Phone:785-422-3049
Mailing Address - Fax:785-214-5018
Practice Address - Street 1:2601 ANDERSON AVE STE 202
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-2809
Practice Address - Country:US
Practice Address - Phone:785-422-3049
Practice Address - Fax:785-214-5018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-07
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
84-4065311OtherBEHAVIORAL HEALTH