Provider Demographics
NPI:1932679859
Name:PREPARE TO CHANGE CHILD AND FAMILY COUNSELING
Entity Type:Organization
Organization Name:PREPARE TO CHANGE CHILD AND FAMILY COUNSELING
Other - Org Name:PREPARE TO CHANGE, A PSYCHOLOGY CORPORATION
Other - Org Type:Other Name
Authorized Official - Title/Position:DOCTOR/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KANEEZA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAFIR
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:562-773-3044
Mailing Address - Street 1:222 W MAIN ST STE 101
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-7711
Mailing Address - Country:US
Mailing Address - Phone:562-773-3044
Mailing Address - Fax:
Practice Address - Street 1:222 W MAIN ST STE 101
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-7711
Practice Address - Country:US
Practice Address - Phone:562-773-3044
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PREPARE TO CHANGE, A PSYCHOLOGY CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-12-04
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)