Provider Demographics
NPI:1992212328
Name:CHANGING FORWARD, LLC
Entity Type:Organization
Organization Name:CHANGING FORWARD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, PSYCHOTHERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AURELIA
Authorized Official - Middle Name:ETKA
Authorized Official - Last Name:BICKLER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LMFT
Authorized Official - Phone:954-684-6220
Mailing Address - Street 1:1040 BAYVIEW DR STE 110
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304-2532
Mailing Address - Country:US
Mailing Address - Phone:954-800-0818
Mailing Address - Fax:954-800-0910
Practice Address - Street 1:1040 BAYVIEW DR STE 110
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304-2532
Practice Address - Country:US
Practice Address - Phone:954-800-0818
Practice Address - Fax:954-800-0910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-08
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT25589101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty